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i 



CLINICAL HISTORY 



. OF THE CASE OF 



President James Abram Garfield 



BY ROBERT REYBURN, A.M., M.D. 

M 
PROFESSoft OF PHYSIOLOGY AND CLINICAL SURGERY MEDICAL DEPART- 
MENT HOWARD UNIVERSITY, WASHINGTON, D. C, AND ONE OF 
THE ATTENDING SURGEONS IN THE CASE OF 
PRESIDENT GARFIELD. 




REPRINTED FROM THE 

JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 

MARCH n to MA Y 5, im. 



CHICAGO: 

PRINTED AT THE OFFICE OF THE JOURNAL OF THE ASSOCIATION. 

1894. 



Clinical History of the Case of President 
Jaies Abram Garfield. 



BY ROBERT REYBURN, AM., M.D. 




:i.s-^^9-,)i 



.i 



Entered according to Act of Congress, May 29, 1893, by Robert 
Reyburx. M.D. 



.K 



PREFACE. 



THE compiler of the following pages has had two motives 
in view in their preparation. The first of these was to 
leave behind him some memorial of his share in one of the 
most pitiful tragedies of the nineteenth century (as he is the 
sole survivor of the six physicians who attended President 
Garfield). The other, and still stronger motive, was to 
endeavor to do some justice to the memory of his firm and 
steadfast friend, the late Dr. 1). W. Bliss. It is the common 
lot of physicians to sacrifice their comfort, health, and even 
their lives for the welfare of their patients, and Dr. Bliss 
showed these characteristics of the true physician in a 
marked degree during his care of the President. In per- 
forming that duty he sacrificed a most lucrative private 
practice, permanently injured his health and shortened his 
life, and as a reward for these labors was treated with a 
depth of ingratitude, that perhaps may be equalled, but 
certainly has never been exceeded in modern history. 

The notes of the President's case were all written by the 
undersigned in a book procured for the purpose. After the 
death of the President, the records were given by the writer 
to Dr. Bliss (at his request) for publication. Owing to the 
failing health of Dr. Bliss this was never done, and the book 
only came into the writer's possession in the month of June, 
1892. This-statement will explain why the publication has 
been so long delayed. Liberal use has been made in these 
pages of the following articles written by Dr. Bliss, viz.: 
Medical Record (New York) Oct. 8, 1881, p. 393. Ibid, July 15, 
1882, and one in the Century magazine for December, 1881, p. 
298. But little use has been made of other authorities, but 
where they have been used it has been intended to give them 
credit. My thanks are due to Dr. D. S. Lamb of the Surgeon- 
General's office for the photographs of the vertebra3 of 
President Garfield, reproduced in this volume. 

Robert Reyburn, A.M., M.D. 



LIST OF ILLUSTRATIONS. 



Fig. 1.— Lateral view (right side) of bodies and spinal 
processes of twelfth dorsal and first and second lumbar 
vertebrae of President Garfield. 

Fig. 2.— Anterior surfaces of the twelfth dorsal and first 
and second lumbar vertebrae of President Garfield. 

Fig. 3.— Oblique view of twelfth dorsal and first and second 
lumbar vertebrae of President Garfield, showing wound of 
•entrance, wound of exit, and carious condition of bodies of 
vertebrae. 

Fig. 4.— Antero-posterior section through bodies and 
spinous processes of twelfth dorsal and first and second 
lumbar vertebrae of President Garfield showing their carious 
condition. 

Fig. 5.— Oblique view (from leftside) of the twelfth dorsal 
and first and second lumbar vertebra^ of President Garfield. 

Fig. 6.— Diagram of posterior surface of the body of 
President Garfield, showing point of entrance of bullet, 
and location of bullet when found during the postmortem 
examination. 

Fig. 7.— Chart of the temperature, pulse, and respiration 
of President Garfield from July 2. 1881, to Sept. 19, 1881. 



CONTENTS. 



Chapter I.— Description of the Assassination of President 
Garfield — Collapse and Shock from Internal Hemorrhage. 

Chapter II.— Period from July 2 to July 23, 1881.— Eeac- 
tion— First Rigor with well-marked symptoms of Septicemia 
on July 23, 1881. 

Chapter III.— Period from July 24 to Aug. 8, 1881. Septic 
Infection continues — Counter Openings made to drain wound 
August 8, 1881. 

Chapter IV.— Period from August 9 to Sept. 10, 1881. 
Continuance of Septic Infection— Gradual Exhaustion of 
the Strength of the President— Death of the President on 
Sept. 19,1881 (from secondary hemorrhage). 

Chapter V.— Causes of the Death of President Garfield. 



; \ 



Chapter I. 

Description of the Assassination of PREsiDENr 

Garfield — Collapse and Shock from 

Internal Hemorrhage. 

On the morning of July 2, 1881, President Garfield 
accompanied by Secretary Blaine drove up to the B 
Street entrance of the Baltimore and Potomac depot, 
Washington, D. C, intending with a party composed 
of members of his family, Cabinet and personal 
friends, to take a pleasure trip through the New Eng- 
land States. At 9 : 30 a.m. President Garfield and Secre- 
tary Blaine were walking across the ladies' reception 
room on their way to take the train, when a pistol 
shot was heard, which was immediately followed by 
a second report. There was a rush of those who* 
were present to the reception room, where the Presi- 
dent was found lying on the floor with blood stream- 
ing from two wounds, one a slight flesh wound of the 
right arm, and one of the right side of the body. 
The President turned at the first shot, and fell on his 
knees at receiving the second shot. The first ball 
from the assassin's revolver struck the upper portion 
of the right arm inflicting a slight flesh wound. 
The second bullet entered the right side of the back, 
four inches to the right of the spinal column, and on a 
level with the twelfth, or lowest of the dorsal vertebrse, 
and passing at first forwards, fractured the eleventh 
and twelfth ribs, then being deflected to the lef t,passed 
through the body of the first lumbar vertebra in 
an oblique direction to the left, and emerging thence, 
passed behind and below the pancreas, where it was 
found at the postmortem examination. The second 
ball in its course penetrated some of the branches of 
the mesenteric arteries and grazed the splenic artery. 



8 



The President was laid upon the floor until a mat- 
tress could be procured, and he was at once removed 
to a room in the second story of the depot ; when he 
turned deathly pale, and soon after he was carried 
up stairs he vomited. The assassin attempted to run 
out of the Sixth Street door of the depot, but for 
some reason turned back and was arrested by Officers 
Scott and Kearney. The President's eldest son was 
with him at the time he was shot as well as Secre- 
taries Blaine, Hunt and Lincoln, and Postmaster 
General James. 

Dr. Smith Townshend, the District Health Officer 
was the first physician who came to the assistance 
of the President. He arrived about four minutes 
after the shooting, and states that he found him ly- 
ing upon the floor of the depot, surrounded by an 
immense throng of people. He was in a fainting 
condition, and apparently dying. Dr. Townshend 
administered a stimulant, and by his orders he was 
removed upstairs. Immediately after this Drs. Pur- 
vis and Bliss arrived at the depot. 

Secretary Blaine came out of the reception room 
following a man, and calling, " Rockwell ! Rockwell ! 
Where is Rockwell?" Theman was seized by Officer 
Kearney, and. Mr. Parks, the depot policeman, and 
proved to be Charles J. Guiteau. 

Secretary Blaine was not going with the party, but 
came down to bid the President good-by. He said : 
"The President and I were walking arm in arm 
toward the train. I heard two shots, and saw a man 
run. I started after him, but seeing he was caught 
just as he got out of the room, I came to the Presi- 
dent, and found him lying upon the floor. The floor 
was covered with the President's blood." The weapon 
used by the assassin was a five chambered revolver 
of the English bulldog pattern, with an ivory han- 
dle, and was about seven inches long. This is a 
weapon of strong propulsive power, and experiments 
made with a similar weapon during Guiteau's trial 
showed that it had power enough to penetrate a two 



9 

inch plank at a distance of one hundred feet. When 
arrested Guiteau said: "I did it, and want to be 
arrested. I am a stalwart and Arthur is President 
now. I have a letter here I want you to give to Gen- 
eral Sherman ; it will explain everything. Take me 
to the police station." 

Officers were sent to the police headquarters, by 
order of those around the President, to get the name 
of the assassin. He very willingly wrote his name 
and address on a sheet of paper, as follows : 

" Charles Guiteau, 

Attorney- at-Law, 

Chicago, III." 

The following letter was taken from the prisoner's/ 
pocket at police headquarters, showing conclusively 

the intention to kill the President : 

July 2, 1882. 
'To the White House: 

The President's tragic death was a sad necessity, but it 
will unite the Republican party and save the Republic. 
Life is a flimsy dream, and it matters little when one goes. 
A human life is of small value. During the war thousands 
of brave boys went down without a tear. I presume the 
President was a Christian, and that he will be happier in 
Paradise than here. It will be no worse for Mrs. Garfield, 
dear soul, to part with her husband this way than by nat- 
ural death. He is liable to go at any time, anyway. I had 
no ill-will towards the President. His death was a political 
necessity. I am a lawyer, a theologian and a politician. I 
am a stalwart of the stalwarts. I was with General Grant 
and the rest of our men in New York during the canvass. 
I have some papers for the press which I shall leave with 
Byron Andrews and his co-journalists at 1420 New York 
Avenue, where all the reporters can see them. I am going 
to the jail. Charles Guiteau. 

On the morning of July 2, 1881, at about 9 :45 a.m. 
whilst in my office, I was suddenly summoned by a 
messenger from Dr. D. W. Bliss, who informed me 
that President Garfield had been shot by an assassin, 
at the Baltimore and Potomac depot, and requesting 
my immediate assistance. At first I refused to go, 
being incredulous, but after a few moments' consid- 



10 

eration, I deemed it advisable to go and see for my- 
self if there was any truth in the story, and drove 
rapidly in the direction of the depot. I was soon 
certain that something terrible had just happened. 
From all directions I could see people hastening 
towards the depot as to a common center. Hasten- 
ing up stairs on my arrival I saw President Garfield 
lying on a mattress, which had been hastily pro- 
cured for him, and which had been placed on the 
floor of a room in the second story of the depot. He 
was lying in the northeast corner of the room when 
I first saw him. I asked him, "Mr. President, are 
you badly hurt?" He answered: "I am afraid I am." 
The President was deathly pale, almost pulseless 
and apparently dying from internal hemorrhage. 
Dr. Bliss was present, surrounded by a number of 
physicians, and was evidently recognized by all who 
were there as in full charge of the case. The follow- 
ing account of the condition of the President, when 
first seen by Dr. Bliss is a verbatim copy of his 
statement made to me at Ihe time, and immediately 
recorded by me in the note book of the case : " I rec- 
ognized a very feeble pulse of about forty beats per 
minute, and a marked pallor of the face ; skin cold 
and covered with a clammy perspiration. There was 
sighing respiration which was slow, being about 
twelve to fourteen per minute. The lines of expres- 
sion of the face were changed, and evidences of his 
having recently vomited were apparent. I then 
learned from Dr. Smith Townshend who had preceded 
me, that he had administered one ounce of brandy 
and one drachm of aromatic spirits of ammonia to 
the President. I then proceeded to examine the 
wound, and 'carefully introducing my little finger de- 
tected fractured portion of the eleventh rib and 
determined that the ball had passed forwards and 
slightly downwards into the abdominal cavity. I 
found a clean cut wound four inches to the right of 
spinous process of twelfth dorsal vertebra, between 
the eleventh and twelfth ribs. After withdrawing 



11 

my finger, I introduced a Nelaton probe with great 
caution to the extent of three inches, where its prog- 
ress was arrested by the soft tissues. Deeming it 
hazardous to make any forcible exploration I desist- 
ed, and then informed the medical gentlemen who 
were present that I deemed it unwise to make any 
further examination. I then asked the physicians 
who w^ere present to retire to one of the corners of 
the room for consultation (there being no other 
available place) respecting the propriety of removing 
the President to the White House, and whether or no 
more stimulants should be given. It was then 
thought best on account of his weak condition to 
give him another half ounce of brandy." 

The physicians present at this consultation were 
Drs. D. W. Bliss, Smith Townshend, N. S. Lincoln, 
Basil Norris, P. S. Wales, John B. Hamilton, C. M. 
Ford, D. C. Patterson, C. B. Purvis and Robert Rey- 
burn. The President repeatedly and urgently request- 
ed that he should be removed to the White House. 
After the examination of the wound the President in- 
quired as to the gravity of his injury ; Dr. Bliss replied 
to him that it was quite impossible to give a definite 
opinion at this stage, disguising his own fears as to 
the gravity of the case. The President complained 
very much of a sense of weight and heaviness in his 
lower extremities. After a few minutes he said he 
had a sensation of tingling in his feet, and very soon 
these sensations changed to severe and distressing 
pains in the lower extremities. Half an hour after 
the injury the President's pulse was fifty to the min- 
ute, and though feeble was more full. After the 
consultation it was deemed expedient to remove the 
President to the White House and the ambulance 
was ordered for that purpose. I think I can see 
now the sea of human faces that completely filled 
the space in and around the depot, as we carried him 
down the stairs, and through the depot, with the 
mingled expressions of pity and consternation that 
sat upon each of them. The President was tenderljr 



12 

and carefully taken up by eight men and carried on 
the mattress to the ambulance, and was slowly driven 
to the White House. Dr. Bliss and Dr. Townshend 
accompanying the President in the ambulance. 

At the time of his removal, 10 :30 a.m., he com- 
plained of pains in his feet and legs, pulse 60 to 65. 
At 11 A.M. pulse 74 with more character; patient 
slightly restless, was offered water which he took 
with half an ounce of brandy. After arriving at the 
White House he received a hypodermatic injection of 
one-quarter of a grain of sulphate of morphia, and 
one ninety-sixth of a grain of sulphate of atropia. At 
12 A.M. pulse 94, soft and compressible ; he complains 
■of spasmodic pains in the extremities, which he de- 
scribes as shooting up the legs towards the body. 
These pains became very severe. There is a consid- 
erable hemorrhage which has taken place from the 
wound since his arrival at the White House, and 
there is probably also internal hemorrhage taking 
place. At 12 :30 p.m. pulse 88, no material change ex- 
cept interruption of pulse ; 12 :45 p.m. patient vomited 
and on recovering himself said : " Well, Doctor, I 
suppose that was the result of your hypodermic." At 
1 P.M. pulse 100 and very feeble, sighing respiration 
but complains less of pain in the extremities, has 
pains in the right hip. At 1 :30 p.m. patient is restless, 
has had nausea and has vomited twice ; complains 
of constant pain in the feet, surface cool, tempera- 
ture 96.8, respiration 30 to the minute. The pulse 
and respiration are increasing in frequency, whilst 
the temperature is falling; an ominous sign. 

At 1 :40 P.M. pulse 124 and feeble. Pain in the ex- 
tremities continues about the same ; patient gives 
evidence of extreme prostration ; 2 :15 p.m. pulse 124 
and a trifle better in character ; respiration 32 per 
minute ; complains much of pain in the lower ex- 
tremities. After consultation one-quarter of a grain 
of sulphate of morphia was given hypodermatically ; 
2:45 p.m. pulse 116 and a trifle more*full ; respiration 
•38 per minute ; has less pain and feels more like 



13 

sleeping; is thirsty and asks if it will injure him ta 
take water freely. At 3 :40 p.m. pulse 130, pains in the 
feet more severe. After consultation it was decided 
to give another quarter of a grain of morphia hypo- 
dermatically. At 4:15 p.m. pulse 128; respiration 30 
per minute. Seems easier since receiving the hypo- 
dermatic injection; but has just vomited freely a 
watery fluid. Percussion reveals a marked and well- 
defined dullness in the right hypochondriac region, 
(below lower margin of the liver). 

The President has just made inquiry of Dr. Bliss 
concerning his real condition, which was explained 
to him and he took the announcement of his danger- 
,ous condition quietly and calmly. At 4 :40 p.m. com- 
plains of pains in both feet and ankles, but is other- 
wise comfortable ; 5 :30 p.m. pulse 140 and respirations- 
28 per minute. The President has just vomited; is 
free from pain, but has a sensation of numbness in 
his hands and arms and wants them rubbed. The^ 
respiration is abdominal in character, and is more 
full on the right side than on the left ; 6 :30 p.m. pulse- 
150 and respirations 28 per minute ; occasional sigh- 
ing respiration. The President is cheerful and in^ 
clined to talk to his family and friends. 

commentary on the state of the president. 

In spite of the cheerful condition of the spirits of 
our patient as mentioned above, our prognosis of his 
case at this time was of the most discouraging char- 
acter. He was evidently bleeding internally, and 
unless reaction would soon take place, it was evi- 
dently impossible that he could long survive. Mrs. 
Garfield was absent at Elberon, N. J. She had been 
telegraphed for, and was coming as fast as the express- 
train could bring her to Washington, and yet we had 
grave and w^ell-founded fears that he would die before 
her arrival. 

Our patient lay on the wounded side to facilitate- 
drainage from the wound. He had a sighing respira- 
tion, a feeble and scarcely perceptible pulse; the 



14 



lines of the face hippocratic in character; frequent 
movements of the lower limbs, with regurgitations 
from the stomach. Our anxieties increased with each 
hour. No indications of reaction could be discovered 
^ven by the most sanguine. We measured the time 
with beating hearts, hoping that the illustrious suf- 
ferer might again seethe face he loved so well. The 
President several times made inquiry as to the cause 
of Mrs. Garfield's delay, and, appreciating the gravity 
of his injury, w^as extremely anxious lest she should 
be too late for an intelligent interview. Upon her 
arrival, at 6 :40 p.m., he requested that their interview 
should be entirely private. Thus the prostrate and 
apparently dying husband met his wife. She remained 
by his side not more than five minutes. The words 
of love, hope and cheer given him are known only to 
themselves and to God. It is a fact, however, that 
within an hour the President's symptoms began to 
indicate reaction. 

The President rarely spoke of his condition, seldom 
expressed a want, and only once, in my hearing, re- 
ferred to the circumstance of his shooting. He asked 
the Secretary of State, in the afternoon, the name of 
the assassin. On being told, he said : " Why should 
he have wished to shoot me?" It was explained that 
he had probably been disappointed in seeking some 
office. 

Commentary continued from 8:30 p.m. July 2, to 
morning of July 4. The favorable reaction that took 
place in the condition of the President at 8:30 p.m. 
July 2, gave a relief to the feelings of the attending 
surgeons that may be imagined, but scarcely be ade- 
quately described. The hemorrhage from the splenic 
artery, and which was probably also due to injuries 
received from the bullet by the mesenteric arteries 
was spontaneously arrested, just as our patient was 
on the brink of death. This favorable condition of 
our patient continued during the night, and on the 
morning of July 3 his temperature was 98.6 (normal ) ; 
pulse 126 ; respirations 18 per minute. Drs. Bliss and 



15 

Reyburn remained on duty all the night of July 2 and 
3. Colonel Rockwell, General Swaim, several members 
of the Cabinet, Miss Edson and Steward Crump 
were also at hand to render any needed aid. The 
President enjoyed, upon the whole, considerable re- 
freshing sleep, broken about every half hour by 
regurgitation of the contents of the stomach. The 
morning of July 3 found him comparatively cheerful 
and hopeful, and with a full appreciation of his sur- 
roundings. At this time he inquired of me what his 
chances of recovery were, saying, in his bright and 
cheerful way, that he desired a frank and full state- 
ment — that he was prepared to die, and feared not to 
learn the worst. He added that personally he was 
willing to lay down the heavy burden thrust upon 
him. I replied : 

"Mr. President, your injury is formidable. In 
my judgment, you have a chance for recovery." 

He placed his hand upon my arm, and, turning 
his face more fully toward me, said, with a cheerful 
smile : 

" Well, Doctor, we'll take that chance." 

It was perfectly apparent that there were more 
physicians in attendance upon the President than 
were needed, and Dr. Bliss determined to ascertain 
the President's wishes in the matter. On the morn- 
ing of July 3 after the morning consultation and 
dressing of the wound. Dr. Bliss went to the Presi- 
dent and said : " Mr. President, there are a number 
of the physicians of the city who have kindly volun- 
teered their services and have been associated with 
me in conducting your case successfully through the 
day and night since your injury, and have contributed 
largely to the prospects of your recovery. Now that 
Mrs. Garfield has arrived and you are so comfortable, 
we wish to retire from the case and ask you to select 
your permanent surgeon and his counsel." The 
President replied : 

" I wish you to retain charge of my case, and select 
such counsel as you may think best. Your judgment 



16 

is better than mine on that subject." Dr. Bliss then 
said that if it was agreeable to the President and 
Mrs. Garfield, he would select Surgeon-General 
Barnes, U. S. A., Surgeon Woodward, U. S. A., and 
Dr. Robert Reyburn as his counsel, giving his reasons 
in each case for making the selection. The President 
replied : 

" Doctor, your selection is eminently satisfactory." 
Dr. Bliss then requested permission to thank the 
medical gentlemen in the name of the President and 
Mrs. Garfield, which was accordingly done. As many 
statements have been maliciously made to the effect 
that Dr. Bliss in assuming the charge of the Presi- 
dent did so without due authorization, I herewith 
submit the following documentary evidence which 
will settle the point beyond question. Before me 
lies an official copy of the affidavit made by the 
Honorable Robert T. Lincoln, Secretary of War, and 
dated. War Department, Washington, D. C, May 23, 
1882, and from which the following is an extract : 
" When the President was shot my carriage was at 
the door of the railway station, and within a few 
seconds I hurried it off to bring you (Dr. Bliss)." 
Farther on in the same affidavit the Secretary again 
says: "You (Dr. Bliss) at once took charge of th& 
President, acting with the other surgeons who came^ 
quickly to his help." 



Chapter II. 

Period from July 2 to July 23, 1881. Reaction — 

First Rigor with Well-Marked Symptoms 

OF Septicemia on July 23, 1881. 

The duties of the attending surgeons were at this 
time systematically divided among them as follows : 
Dr. Bliss as chief surgeon in charge of the case re- 
mained on continuous duty every night at the White 
House, from the time the President was shot until 
he was taken to Elberon, N. J., and he continued 
his vigils there until the death of the President. 
During a long and varied professional career, I have 
known many instances of the self-sacrificing devotion 
of physicians to their patients, but I have never 
known such complete self-abnegation as was mani- 
fested by Dr. Bliss in his care of the President. He 
seemed to neither think nor speak of anything, ex- 
cept what concerned the welfare of his illustrious 
patient. All the medicine and all the articles of 
diet were either administered by him or under his 
immediate direction. Surgeon-General Barnes came 
twice a day in consultation with the other sur- 
geons. To Dr. J. J. Wood\vard was intrusted the 
duty of preparing and writing the daily bulletins of 
the case, and along with Dr. Robert Reyburn assisted 
in taking the temperature, pulse and respiration, 
which was done at least three times a day. This 
naturally became after a w^hile rather wearisome to 
the President. On my coming into the room one 
day he smiled, and said : "Here comes old tempera- 
ture again." To Dr. Reyburn was assigned the duty 
of taking notes of the case, which w^ere written each 
day by him in a book procured for the purpose. Drs. 
Woodward and Reyburn slept each night alternately 



18 

in the White House, and were always on hand to 
furnish such assistance as might be required. The 
nursing of the President was done by Colonel Rock- 
well, General Swaim, Dr. Boynton, Dr. (Miss) 
Edson, Steward Crump, and the faithful body ser- 
vant of President Garfield. These all rendered faith- 
ful and meritorious services, and their devotion to 
the President deserves the highest praise. Mr. J. 
Stanley Brown, Private Secretary to the President 
was on almost continuous duty during the Presi- 
dent's illness, and gave all the aid in his power. The 
labor of nursing the President, I may here remark, 
was much more severe than it would seem to be. In 
the first place, during a large part of the President's 
illness it was impossible for him to turn in bed, or 
even to bend his spine. In order, therefore, to pro- 
mote his comfort and prevent bedsores, it was neces- 
sary to turn him, or to change his position in the 
bed very many times during the twenty- four hours — 
this would sometimes reach fifty, sixty or even one 
hundred times a day. Strong linen sheets were kept 
under him for the purpose of moving him. When 
he required a change of position, three persons, 
either doctors or nurses (as they happened to be in 
the room at the time) came on each side of the bed, 
and taking hold of the sheets gently rolled him over 
to the side he wished to go. For the same reason 
every passage of his bowels and urine required the 
same attendance bestowed upon a young infant. 
The President was a man of large and massive 
frame (he was over six feet in height and weighed 
two hundred pounds the day before he was shot), so 
it will be readily understood that the physical labor 
devolving upon his nurses and medical attendants 
was quite severe. Until the President was removed 
to Elberon, N. J., the medical bulletins of his case 
were prepared in conjunction with the other attend- 
ing surgeons exclusively by Dr. Woodward and my- 
self. Mentioning this fact recalls the many harsh 
criticisms which were made concerning the roseate 



19 

statements which the bulletins gave of the Presi- 
dent's condition. These bulletins were often the 
subject of animated and sometimes heated discus- 
sion between Dr. Bliss and the other attending sur- 
geons, the surgeons usually taking one side of the 
question and Dr. Bliss the other. The ground taken 
by Dr. Bliss was that in the President's case it was 
vitally necessary to keep from him every unfavor- 
able symptom, for by so doing we gave him his only 
desperate chance of recovery. It must be remem- 
bered that during almost all of his illness he was 
able to have the newspapers read to him, and he 
always asked for them every morning. If the slight- 
est unfavorable symptom was mentioned in one of 
the bulletins, it was instantly telegraphed all over 
the country, and appeared in every newspaper the 
next morning. In fact, during the early part of the 
case he very often read the newspapers himself. 
We were placed in a very embarrassing position; on 
the one hand we did not wish to dishearten our 
patient by circulating discouraging reports of his 
condition, and on the other hand we wished to do our 
duty to ourselves and to the people of the whole 
country, who watched with such intense eagerness 
every word of intelligence that came from us. 

During the early part of the day of July 3 the 
President's temperature remained about normal ; 
towards evening a slight rise in temperature took 
place, reaching 100 at 10:30 p.m. He slept a good 
deal during the night of July 2-3, and in the morn- 
ing took with relish equal parts of milk and lime 
water. He complained often during the day of 
severe pains of a lancinating character in the scro- 
tum, both feet and ankles ; he complained also of 
sensations of pricking and numbness in the same 
members. These symptoms were no doubt due to the 
concussion of the spinal cord produced during the 
passing of the bullet through the body of the fourth 
lumbar vertebra. So marked were these symptoms 
for the first few davs after he was wounded, that it was 



20 

feared that the spinal cord itself might have been 
injured. Of course the after history of the case 
(from the gradual disappearance of these symptoms) 
showed that such could not have been the case. Ap- 
plications of cloths wrung out of hot water not 
relieving him entirely, he was given a hypodermatic 
injection of one- quarter of a grain of sulphate of 
morphia. He seemed cheerful and full of hope and 
amused himself by telling us a laughable incident of 
his early life. Slight tympanites was detected dur- 
ing the day, but no pain on pressure, nor any marked 
rigidity of the abdominal walls. This was the only 
symptom that pointed to the existence of peritonitis 
during the whole history of the case. During the 
night of July 3-4 the patient dozed at intervals. 
When awake he complained so much of the pains in 
his feet that he was given another quarter of a grain 
of sulphate of morphia hypodermatically ; 7: 30 a.m., 
he has vomited at intervals of twenty minutes dur- 
ing the past two hours. Gave one-half ounce of 
milk and lime water every hour, with powders of 
four grains of subnitrate of bismath, two grains of 
oxalate of cerium in each one ; to be given when re- 
quired. Surgeons Dr. D. Hayes Agnew of Philadel- 
phia, and Dr. Frank Hamilton of New York, having 
been summoned in consultation, arrived this morn- 
ing. Dr. Agnew arrived at 4:30 a.m., and saw the 
President, but postponed the examination of the 
wound until the arrival of Dr. Hamilton at six 
o'clock. They were formally presented to the Presi- 
dent and we held our consultation at 7 :30 a.m. On 
dressing the wound there was found to be a very 
slight discharge from it, and scarcely any swelling 
or inflammation around the track of the wound. A 
careful review of the case- was given to the consult- 
ing surgeons by Dr. Bliss, with the request that they 
should, with the data before them, examine the case 
thoroughly, as though it was their own, and freely 
express their views concerning the character and 
gravity of the injuries, and the course of treatment 



21 

up to that time. He also gave them a detailed ac- 
count of the explorations made in the wound, and 
the unsettled opinions as then held as to the course 
of the missile, and the organs involved in the injury. 
Carefully weighing all the evidence, the more prom- 
inent symptoms upon which the diagnosis was made 
were presented in the following order: The relative 
position of the assassin to the President at the time 
of the shooting, the direction of the bullet through 
the tissues as far as it could be determined, the 
amelioration of pain and hyperesthesia in the feet 
and ankles and scrotum, the repeated unsuccessful 
efforts to pass a probe or flexible instrument more 
than half an inch in any direction beyond the frac- 
tured rib, except in a direction downward, a little 
forward and anterior to the twelfth rib, where it 
could be passed about two inches. Neither the signif- 
icance of the profound shock was underestimated, nor 
the lengthened period of collapse which followed, 
and which seemed to point to extensive lesions of 
important viscera. However, the fact that the kid- 
neys, intestine and peritoneum had not been seri- 
ously injured, was shown by the passage of normal 
urine, the spontaneous movements from the bowels 
of natural feces, the discharge of flatus, and the 
absence of other symptoms of peritonitis. It was 
found to be impossible to determine positively the 
course taken by the bullet, but the indications 
pointed to a downward course into the pelvic cavity. 
The absence of any symptoms that could be attrib- 
uted to a lesion of the liver, also showed that it had 
escaped serious injury. 

They individually examined the wound with great 
care. These examinations consisted in the introduc- 
tion in dill'erent directions, of probes and flexible 
bougies, in order if possible to determine the course 
of the bullet. With the evidences developed by this 
personal examination, together with the complete 
history given them of the shooting of the President, 
the consulting surgeons proceeded to discuss the 



22 

possible course of the bullet and the organs involved. 
The propriety of making extensive incisions and dis- 
sections, so as to explore the fractured ribs and re- 
move as much as might be necessary to reveal the true 
course of the bullet, was fully considered. It was 
finally determined, however, that the favorable condi- 
tion of the President thus far, did not warrant such 
interference, and further such an operation would 
seriously complicate the case and diminish the pros- 
pects of recovery. 

The consulting surgeons issued the following bul- 
letin to-day after the consultation : 

July 4, 1881. 
"We held a consultation with the physicians in charge of 
the President's case at 7:30 a.m. to-day, and approve in 
every particular of the management and care of the case, 
and of the course of treatment which has been pursued. 

Frank H. Hamilton of New York. 

D. Hayes Agnew of Philadelphia. 

At the time of the consultation his temperature 
was 99:4; pulse 104; respiration 19. He suffers con- 
siderabl}^ from pains in the feet, and cloths saturated 
in camphorated tincture of opium were applied to 
them; some vomiting of a clear fluid tinged with 
bile. Stopped giving nourishment at 10 :oO a.m., and 
gave two teaspoonfuls of lime water with cracked 
ice. At 1 P.M. it was deemed necessary to give him 
another hypodermatic injection of one-eighth of a 
grain of sulphate of morphia. He then received the 
following prescription : Carbolic acid solution fif- 
teen drops and lime water four ounces ; mix and 
give a tablespoonful every hour. 

At 3 :30 P.M. The President has slept at intervals, 
and on waking expressed himself as feeling more 
rested. Still continues to vomit at intervals of 
about thirty minutes, without straining or nausea, 
and only about an ounce of fluid is ejected each 
time; 4:30 p.m., patient is more restless, and is more 
indifferent to surroundings ; received another eighth 
of a grain of morphia hypodermatically ; 7:45 p.m., 
(bulletin.): The President is not so comfortable. 



23 

He does not suffer so much pain in the feet The 
tympanites is again more noticeable ; temperature is 
1U1.9; pulse 126; respirations 24. 

Telegrams of inquiry and condolence were show- 
ered in a perfect avalanche on the White House dur- 
ing the early part of the President's illness They 
€amefrom Vice-President Arthur, ex-President Grant 
trom the off cials of the various States of the Union, 
and indeed from almost every prominent public man 
m the United States. This interest was not sectional 
in character. South as well as North, East as well as 
\V est, vied with each other in showing their sympa- 
thy with our stricken Chief Magistrate. Probably 
never in the history of the world was there such an 
outpouring of friendly feeling as was manifested in 
the case of President Garfield. The Queen of Eng- 
land was among the first to express her sorrow and 
best wishes for his recovery. This was followed by 
messages from all the crowned heads of Europe, as 
well as from many of the officials and public men of 
the different countries of Europe. 

As to the letters received, their name was legion. 
During the whole time, indeed, of our attendance upon 
the President the mail received at the White House 
assumed alarming proportions. We received every 
morning literally bushels of letters, and many of 
them were of the most ordinary character. Every 
crank and vendor of patent medicines in the country 
seemed to think himself called upon to offer to cure 
the President. One man gravely suggested that the 
President's body should be inverted- for some hours 
in order that the bullet might gravitate downwards, 
and thus aid in its removal. Another sent a draw- 
ing of a machine composed of a rubber tube and an 
air-pump. The rubber tube was to be introduced 
into the wound until it came in contact with the 
bullet, then the air-pump was to be attached to it, 
and by suction the bullet removed. I wish now I 
had retained some of the most absurd of these mis- 
sives, but at the time of receiving them we were too 



24 



busy to appreciate either their absurdity or com- 
icality. 

July 5, 8 :30 a.m. The President has passed a com- 
fortable night, and his condition this morning is de- 
cidedly more favorable. There has been no vomit- 
ing since last evening at 8 p.m., and he has been able 
to retain the liquid nourishment administered. There 
is less tympanites and no abdominal tenderness ex- 
cept in the region of the wound. Temperature 100 ; 
pulse 114; respirations 24. 

The following dispatch was sent by the surgeons 
in charge to the consulting surgeons : 

July 5, 9 :30 a.m. 
After you left the urgent symptoms continued. There 
was much restlessness, constant vomiting, and by 8 o'clock 
P.M. the President's condition seemed even more serious than 
when you saw him. Since then his symptoms have gradu- 
ally become more favorable. There has been no vomiting 
or regurgitation of fluid from the stomach since 8 o'clock 
last evening. The President has slept a good deal during 
the night, and this morning expresses himself as feeling 
comparatively comfortable. The spasmodic pains in the 
lower extremities have entirely disappeared, leaving behind, 
however, much muscular soreness and tenderness to the 
touch. There is less tympanites and no abdominal tender- 
ness whatever except in the hepatic region. Since 8 p.m. 
(July 4) he has taken an ounce and a half of chicken broth 
every two hours and has retained it all. The wound was 
dressed antiseptically this morning. Altogether but one- 
half a grain of morphia has been given hypodermatically 
during the past twenty-four hours, and it has been found 
quite sufficient. His pulse, however, still keeps up. At 8:30 
A.M. it was 114 ; temperature lt)0.5 ; respirations 24. Seventy- 
two hours have now elapsed since the wound was received. 
We can not but feel encouraged this morning, though of 
course we do not overlook any of the perils that still beset 
the path towards recovery. The course of treatment 
agreed upon will be steadily carried out. 

D. W. Bliss, 
J. J. Woodward, 
J. K. Barnes, 
RoBT. Reyburx. 

July 5, 12:30 p.m. The favorable condition of the 
President continues, and at noon he had a natural 
sleep. Temperature 101; pulse 110; respirations 



25 

24. July 5, 8:30 p.m. Favorable condition un- 
changed. Temperature 100.9; pulse 106; respira- 
tions 24. 

As above mentioned, the wound of the President 
was dressed antiseptically, and this continued to be 
the case during the entire time of the treatment. 
The most scrupulous cleanliness of the instruments, 
and surgical appliances was observed, and also of 
the antiseptic solutions used for the daily washing 
out of the wound, and every effort was made to 
render them as aseptic as possible. The solution 
used was a freshly made one of carbolic acid in 
water, varying in strength, sometimes a 1 per cent. 
and sometimes a 2 or 3 per cent, solution being 
made. With this a solution of permanganate of 
potash of the strength of one to three grains to the 
fluid ounce of water was alternated. The carbolic 
spray was also invariably used during the dressing 
of the wound. It must be remembered that the 
technique of antiseptic, or more properly speaking, 
aseptic surgery was not so thoroughly appreciated or 
carried out bv operating surgeons in 1881 as it is in 
1892. 

July 6, 8:30 a.m. The President slept well, and 
said this morning that he passed the most comfort- 
able night he had had since he had been shot. He 
feels some desire for solid food, but was only given 
chicken broth, with white of egg, one ounce every 
two hours. Temperature 98.9; pulse 98; respira- 
tions 23. July 6, 12:30 p.m. Temperature 98.7; 
pulse 100; respirations 23. 

July 6, 8:30 p.m. His condition continues favora- 
ble, and he takes more nourishment than yesterday. 
Temperature 100.6 ; pulse 104 ; respirations 23. July 
6, 11 P.M. The President continues to take chicken 
broth with white of an egg one ounce every two hours. 

At 9 :30 P.M. received one- quarter of a grain of sul- 
phate of morphia, hypodermatically, and is now sleep- 
ing quietly, though he occasionally awakes and asks 
for ice water. A decidedly yellowish hue of the skin 



26 

has made its appearance during the past two days, 
but is scarcely pronounced enough to call it icter- 
oid. He complains of great muscular weakness and 
of the tenderness of the skin of the feet and ankles. 

July 7, 9 A.M. The President slept last night 
until 8:30 this morning, when he awoke feeling re- 
freshed and free from pain. He retains his nourish- 
ment. The wound was dressed antiseptically ; very 
little discharge from the wound. Temperature 98.2 ; 
pulse 108; respirations 23. 

July 7, 2:30 P.M. The President vomited twice 
this morning, and complains of acidity of the stom- 
ach. Powders containing each fifteen grains of bi- 
carbonate of soda were given him, and the surface 
of his body thoroughly and frequently sponged off. 
Temperature 101.4; pulse 108; respirations 24. 

July 7, 8 to 11 :30 p.m. He asked for the hypoder- 
matic injection at 8 p.m., and slept until 11 p.m. He 
then awoke suffering very much from pain in his 
ankles. Some solution of bromid of potassium was 
sent for, but he fell asleep before it could be admin- 
istered. Temp. 100.2; pulse 106; respirations 23. 

July 8, 8:15 a.m. The President slept well during 
the night, and awoke at 6:30 a.m., in good spirits. 
Wound dressed antiseptically at 8:15 a.m. A slight 
slough separating from edges of wound with lauda- 
ble pus. Very little inflammation around edges of 
wound. At 8 a.m. he took five grains of bisulphate 
of quinia. Temperature 99.2 ; pulse 96 ; respirations 
23. 

July 8, 1 P.M. Temperature 101.4; pulse 106; res- 
pirations 24. 

Bulletin to consulting surgeons, Drs. Agnew and 
Hamilton : 

July 8, 1 P.M. 
The President's condition has not changed materially 
since our last telegram to you yesterday. During yesterday 
afternoon he was again troubled with acid eructations, and 
the administration of nutrients was again suspended for a 
few hours. One quarter of a grain of sulphate of morphia 
was given hypodermatically at 8 :30 p.m., and was followed 



27 

by tranquil sleep ; towards midnight, however, he became 
restless, and complained a good deal of muscular soreness in 
his feet and ankle joints, so that we were on the point of ad- 
ministering an additional anodyne, when he fell asleep and 
on awaking was so free from pain that it was not adminis- 
tered. After 1 A.M. he passed the night tranquilly, sleeping 
composedly much of the time. He at intervals since that 
time has taken one ounce of albuminized chicken broth, 
alternating with an ounce of milk to which a teaspoonful of 
very excellent rum has been added; all this has been 
retained as well as five grains of bisulphate of quinia taken 
this morning at 8 a. m. The yellowish hue of the skin men- 
tioned in our last telegram has sensibly diminished. When 
the antiseptic dressing was renewed this morning, the wound 
was found to be discharging a small quantity of healthy 
looking pus. The reaction accompanying the establishment 
of suppuration is, as might be expected, marked by a slight 
rise of temperature and pulse as compared with the same 
corresponding hours of yesterday; this however, we do 
not regard as unfavorable under the circumstances, and we 
should not be surprised if it continued during this after- 
noon and evening, or even for a day or two. July 8, 8 p.m. 
Temperature 101.3; pulse 108; respirations 24. 

(Signed) D. W. Bliss, 

J. J. Woodward, 
J.K.Barnes, 
RoBT. Reyburn. 

July 8, 10 p.m. During the afternoon and evening, 
the milk in one ounce doses was given with one tea- 
spoonful of rum,alternating with albuminized chicken 
broth, and at 7 :30 p.m. his wound w^as again dressed. 
He expressed himself as feeling very tired, and a 
quarter of a grain of sulphate of morphia was given 
hypodermaticaljy; after this he slept for nearly 
three hours. The same nourishment was continued 
during the night, and no nausea or other inconven- 
ience was experienced. 

July 9, 3 A.M. Came in and found him complain- 
ing of pains in the ankles; found them cold and 
wrapped them up in warm blankets, giving relief. 
July 9, 8 A.M. Wound was dressed antiseptically, 
and a small slough separated from the edges of the 
wound, with about two drachms of pus. Two ecchy- 
moses showed themselves in the right hypochon- 
drium. He was given at 9 a.m. ten grains of bisulphate 



28 

of quinia, and the milk in closes of one and a half 
ounces with a teaspoonful of rum was steadily given 
during the day. Temperature 99.4 ; pulse 100 ; res- 
pirations 24. July 9, 1 P.M. Temperature 101.2: 
pulse 104; respirations 22. July 9, 7 :15 p.m. Tem- 
perature 101.9; pulse 108; respirations 24. July 9, 
8:15 P.M. Received a quarter of a grain of morphia 
hypodermatically, and went to sleep in a few 
minutes. 

July 10, 8 A.M. The President passed the most com- 
fortable night he has experienced since he was 
wounded, sleeping tranquilly and w4th few breaks. 
July 10, 8 A.M. Temperature 100; pulse 106; res- 
pirations 23. July 10,1 P.M. Temperature 100.5; 
pulse 102; respirations 22. July 10, 7 p.m. Tem- 
perature 100.9; pulse 108; respirations 24. 

The wound was dressed at 8 a.m. and he expressed 
himself as feeling easy with a desire for further 
sleep; after the wound was dressed he fell asleep for 
nearly an hour and his pulse fell to 100. The milk 
and rum were continued during the day. His condi- 
tion was favorable until 5 p.m. when he complained 
of great weariness and required many changes of 
position. The wound was dressed at 6:30 p.m. and 
one-quarter of a grain of morphia was given hypoder- 
matically. 

Dispatch to the consulting surgeons, Drs. Agnew 
and Hamilton : 

July 10, 1881. 

Such slight changes as have taken place in the Presi- 
dent's condition since our telegram of yesterday are of a 
favorable character. About 7 p. m. his bowels were freely 
moved ; shortly afterwards he received a hypodermatic in- 
jection of a quarter of a grain of morphia. He slept more 
naturally during the night than he has done since he was 
shot, and this morning is taking his nourishment well and 
appears on the whole better than hitherto. During the last 
twenty-four hours he has taken altogether fourteen ounces 
of milk and one ounce of rum. This morning at 10:30 he 
again received ten grains of bisulphate of quinia. Both yes- 
terday and the day before, the wound was dressed antisep- 
tically twice in the twenty-four hours. This morning it is 



29 



discharging less pus than yesterday, but its appearance is 
healthy. (Signed) D. W. Bliss, 

J. K. Barnes, 
J. J. Woodward, 
RoBT. Reyburn. 

July 11, 8 A.M. Temperature 99.2 ; pulse 98; res- 
pirations 23. July 11, 1 P.M. Temperature 99.8; 
pulse 106; respirations 24. July 11, 8 p.m. Tem- 
perature 102.8; pulse 108; respirations 24. 

The President slept well during tlie early part of 
the night. From 2 to 5 a.m. was wakeful, but after 
that time slept well until 8 a.m. Has taken more 
nourishment and with relish this morning. The heat 
of the weather at this time was simply dreadful, and 
the President suffered greatly from it. An effort 
was made to cool the air of the room by hanging long 
strips of muslin over light wooden frames, and keep- 
ing them wetted with ice water ; this proving ineffec- 
tive was abandoned. Mr. R. S. Jennings of Balti- 
more, had in operation to-'day an apparatus for cool- 
ing the air in the President's room which was very 
successful. Air was drawn in by an exhaust fan 
through a subterranean chamber, filled with parti- 
tions half an inch apart, covered with Turkish towel- 
ing. The toweling was kept saturated from above 
by the dripping of water holding in solution ice and 
salt. The apparatus furnished from eighteen to 
twenty-two thousand cubic feet of air per hour at a 
temperature of 54 to 56 degrees Fahrenheit. At 
11 o'clock this morning the outside temperature was 
90 degrees Fahrenheit ; at the outlet of the flue from 
the apparatus below, the temperature was 54 degrees, 
while at the head of the President's bed twenty feet 
from the outlet the temperature was 75 degrees. 
The President complained somewhat of a feeling of 
oppression in the chest ; opening the window, how- 
ever relieved him. The President was somewhat 
restless this afternoon, and after 2 p.m. began to be 
more feverish. 

Dispatch to the consulting surgeons, Drs. Agnew 
and Hamilton : 



30 



July 11, 1 P.M., 1881. 
During the past twenty-four hours the favorable pro- 
gress of the President has continued. He has taken and 
retained twenty-two ounces of milk and one ounce of rum. 
This morning at 9 a.m. he had a slice of bread softened with 
milk. At 11:15 a.m. he took fifteen grains of bisulphate of 
quinia. There has been no irritability of the stomach at 
any time. Last evening at 7 :15 p.m. he received a quarter of 
a grain of morphia hypodermatically and slept well during 
the night. The wound was dressed antiseptically yesterday 
evening and this morning, and continues to discharge a 
small quantity of healthy pus. 

(Signed) D. W. Bliss, 

J. J. Woodward. 
J. K. Barnes, 
EoBT. Eeyburx. 

July 11, 7 P.M. Received his hypodermatic injec- 
tion of a quarter of a grain of morphia, and went to- 
sleep almost immediately and slept at intervals dur- 
ing the night. His temperature began to fall early 
in the night, and profuse sweating took place. 

July 12 at 4 a.m. his pulse was 94 and his respira- 
tions 21 per minute while he was asleep. July 12, 
8 a.m. Temperature 99.6 ; pulse 96; respirations 22. 
July 12. 1 P.M. Temperature 100; pulse 108; respi- 
rations 23. July 12, 7 p.m. Temperature 102.4; pulse 
104 ; respirations 24. 

July 12, 8 a.m. The President is feeling comfort- 
able this morning. The rise in temperature noted in 
last evening's bulletin recurred, but came on an hour 
later. Wound was dressed antiseptically, very little 
secretion from wound. A two-inch decalcified drain- 
age tube was tied into the wound. July 12, 1 p.m. 
The President is passing a comfortable day, and is 
much less restless than yesterday. Has more strength 
and power of movement in his limbs. 

The following dispatch w^as sent to the consulting 
surgeons, Drs. Agnew and Hamilton, to-day: 

July 12, 1881. 
During the afternoon yesterday the President's tempera- 
ture rose to the highest point it has yet attained. It began 
to fall, however, immediately after he received his evening 
dose of morphia — one grain of the sulphate hypodermatically, 
and this morning it corresponds with previous days. About 



31 

6 P.M. he had a copious and consistent movement from the 
bowels. His wound was dressed antiseptically yesterday 
evening and this morning. He continues to retain all the 
nourishment prescribed him, and has had twenty-four ounces 
of milk and one ounce of rum during the past twenty-four 
hours besides a small quantity of milk toast this morning. 
At 8:30 P.M. he received ten grains of bisulphate of quinia. 
His general condition this morning appears to us to be 
rather better than yesterday morning. 

(Signed) ' D. W. Bliss, 

J. J. Woodward, 
J. K. Baknes, 
KoBT. Reyburx. 

July 12, 7 P.M. The President's wound was dressed 
antiseptically, the drainage tube w^as removed, thor- 
oughly cleansed, dipped in carbolized oil (1 to 12) 
and reinserted. The secretion from the wound was 
much more abundant than in the morning, and was 
rather serous in character. At 12 p.m. the President re- 
ceived his usual hypodermatic injection of a quarter 
of a grain of sulphate of morphia, and slept quietly 
during the greater part of the night, occasionally 
awaking. At 5 a.m. (July 13) he took four ounces of 
milk and one teaspoonful of rum. 

July 13, 9 A.M. Temperature 98.5; pulse 90; respi- 
rations 20. July 13, 1 P.M. Temperature 100.6; pulse 
94; respirations 22. July 13,7 p.m. Temperature 
101.6; pulse 100; respirations 24. 

July 13, 8:30 a.m. The President is doing well this 
morning. His gradual progress towards recovery is 
manifest and thus far without serious complications. 
He took ten grains of bisulphate of quinia at 8 a.m. 
He took four ounces of milk and one teaspoonful of 
rum every two hours during the day, also a slice of 
milk toast and a little breast of woodcock. The 
President had less fever this afternoon than either 
yesterday or the day before. Wound was dressed at 
6:15 p.m. Pus flowing freely from it. At 6 :30 p.m. 
had the usual hypodermatic injection of a quarter of 
a grain of sulphate of morphia. 

Dispatch to the consulting surgeons, Drs. Agnew 
and Hamilton : 



July 13, 1 P.M. 
The febrile rise yesterday afternoon was less marked and 
occurred at a later hour than on the previous day, and to- 
day for the first time the President's temperature fell to the 
normal point. The general progress of his symptoms ap- 
pear more favorable than hitherto. During the last twenty- 
four hours he has taken thirty-two ounces of milk and one 
ounce of rum. This morning he had also a slice of milk 
toast, and chewed the breast of a woodcock, but did not care 
to swallow the meat. He had last night one-quarter of a 
grain of sulphate of morphia hypodermatically. In no 
twenty-four hours during the p^st week has he received 
more than a single dose of this quantity, and he slept well 
during the night. This morning he received ten grains of 
bisulphate of quinia. (Signed) D. W. Bliss, 

J. J. Woodward, 
J. K. Barnes, 
RoBT. Reyburx. 

July 14, 7:30 a.m. The President slept quietly dur- 
ing the greater part of the night, but was awake from 
1 to 3 A.M. Wound dressed at 7 :45 a.m., free suppu- 
ration from the wound, and a new drainage tube was 
inserted. He had ten grains of bisulphate of quinia 
at 8:15 a.m. Takes his milk and rum every two 
hours. He ate a slice of milk toast this morning. 
After his wound was dressed, about 8 :30 a.m., he had 
a profuse sweat and complained of coldne&s of the 
extremities. Bottles of hot w^ater were applied and 
he was wrapped in hot blankets until reaction took 
place, which occurred in about one hour and a half. 

July 14,8:30 a.m. Temperature 99.8 ; pulse 90; 
respirations 22. July 14, 1 p.m. Temperature 98.5 ; 
pulse 94; respirations 22. July 14, pulse 94; tem- 
perature 98.5 ; respirations 22. July 14. The Presi- 
dent during the greater part of the day was free from 
fever, but was sweating quite profusely. 

Bulletin to the consulting surgeons, Drs. Agnew 

and Hamilton : 

July 14, 1 p. M. 

The President has continued to progress favorably during 
the last twenty-four hours. The febrile rise yesterday after- 
noon was again less than on the preceding day. He has 
taken since our last telegram twenty-nine ounces of milk, 
and an ounce of rum, as heretofore, beside a small slice of 



milk toast this morning, and at noon a small sandwich of 
scraped raw beef, with two teaspoonfals of Valentine beef 
juice, and an ounce of Tokay wine of 1868. The medication 
has consisted of a single hypodermatic injection of one- 
quarter of a grain of morphia, given last night, and ten 
grains of bisulphate of quinia at 8 a.m. to-day. We admin- 
istered yesterday at 6 p.m. an enema of soap and water 
which was promptly followed by a copious movement of 
normal consistence and color. 

(Signed) D. AV. Bliss, 

J. K. Barnes, 
J. J. Woodward, 

KOBT. E.EYBURX. 

The febrile rise this afternoon w^as less pronounced, 
and did not cause so much discomfort as yesterday. 
At 8 :15 P.M. three- sixteenths of a grain of sulphate of 
morphia was given him. He went to sleep very soon 
and slept profoundly the greater part of the night. 

July 15, 8:30 a.m. Temperature 98.5; pulse 90; 
respirations 18. July 15, 1 p.m. Temperature 98.5 ; 
pulse 94 ; respirations 18. July 15, 7 p.m. Tempera- 
ture 100.4 ; pulse 98 ; respirations 20. This morning 
the President partook of some juice of rare roast 
beef on toast, and Valentine meat juice with a glass 
of Tokay wine. His wound was dressed at 8 a.m. 
and was suppurating freely; the drainage tube w^as 
reinserted. 

July 15, 9:30 a.m. three grains of bisulphate of 
quinia was given, and this dose was repeated at 4 p.m. 
and at 8 p.m. At 12 m. he received fifteen drops of 
aromatic sulphuric acid and also at 5 p.m. During 
the day the President took more solid food. He 
complains of pains in his feet, but does not sweat 
as much as yesterday. 

The following report was sent to the consulting 
surgeons, Drs. Agnew and Hamilton : 

July 15. 

The President continues to do well. Tlie afternoon fever 
is daily less marked. A smaller quantity of milk has been 
given, and solid food substituted and relished. He has had 
less rum, and at intervals of several hours has taken some 
Tokay wine, in all about two ounces and a half of the latter. 
Last night his hypodermatic injection consisted of three- 



34 



sixteenths of a grain of morphia which proved sufficient to 
secure rest. This morning we have altered the dose of 
quinia to be taken three times a day. 

(Signed) D. W. Bliss, 

J. K. Barnes, 
J. J. Woodward, 
RoBT. Reyburn. 

July 15, 7 P.M. The President has continued to do 
well during the day. The afternoon fever has been 
slighter than on any other day since the 3rd of July, 
At 8:15 P.M. he had a hypodermatic injection of one- 
eighth of a grain of sulphate of morphia. He slept 
well during the night and awoke in the morning much 
refreshed. 

July 16,8:30 a.m. The President has passed another 
good night, and seems to steadily progress towards 
convalescence. July 16, 8:30 a.m. Temperature 98.4; 
pulse 94 ; respirations 18. No bulletin issued at 1 p.m. 
July 16, 7 P.M. Temperature 100.2 ; pulse 98 ; respi- 
rations 19. 

Bulletin to the consulting surgeons. Dr. Agnew 

and Hamilton : 

July 16, 7 p.m. 
The President progresses steadily towards convalescence. 
During the last twenty-four hours he has had but one-eighth 
of a grain of sulphate of morphia, in a single hypodermic 
injection at bedtime. He slept well and this morning 
expresses himself as feeling quite easy. The quinia is 
continued in three grain doses three times a day. He is 
taking a still larger proportion of solid food, and with more 
relish than hitherto. Some old port wine has been substi- 
tuted for the Tokay, its flavor being preferred by the 
patient. The febrile rise yesterday was less than on any 
day since you saw him. Hereafter our daily dispatch to you 
will be sent after the evening consultation. 

(Signed) D. W. Bliss, 

J. K. Barnes, 
J. J. Woodward, 
RoBT. Reyburn. 

July 16, 7 P.M. The President has passed a better 
day than any since he was hurt. At 6:30 p.m. he 
received one- eighth of a grain of sulphate of mor- 
phia hypodermatically, and slept excellently dur- 
ing the night. July 17, 8:30 a.m. Temperature 



35 

98.4; pulse 96; respirations 18. July 17 1pm 
Temperature 98.5 ; pulse 90; respirations 18. July 
}■' ^ on^^^' Temperature 100.2; pulse 98; respira- 
tions 20. July 17, 8:30 a.m. The President con- 
tmues to improve; he passed an excellent night and 
has a good appetite this morning. He took oatmeal 
and milk, lamb chops and bacon for breakfast. 

Dispatch to the consulting surgeons, Drs. Agnew 
and Hamilton : 

July 17, 7 p.m. 
Since our dispatch of yesterday the President has done as 
our hopes then indicated. He has had a single hvpoder- 
matic injection of one-eighth of a grain of sulphate of mor- 
phia at bedtime, and slept well. Quinia in three grain doses 
has been continued as well as the plan of nourishment 
hitherto reported. His bowels have been kept free by ene- 
mata. The wound is dressed with antiseptic precautions 
twice daily; there is now a free discharge of healthy pus. 
The afternoon fever both yesterday and to-day has been 
comparatively slight. 

^Signed) D. w. Bliss, 

J. K. Barnes, 
J. J. Woodward, 
RoBT. Reyburx. 

July 17,7 P.M. Our expectations of favorable prog- 
ress have been fully realized by the manner in which 
the President has passed the day. He has taken 
more solid food and with greater relish than hitherto. 
His afternoon fever which is as slight as that of yes- 
terday came on later. He received his hypodermatic 
injection of one-eighth of a grain of sulphate of mor- 
phia at 8:15 p.m. and went almost immediately to 
sleep. He slept well until between 4 and 5am of 
July 18. ' ' 

July 18, 7 A.M. The President had a profuse per- 
spiration this morning after 5 a.m., and felt quite 
tired after his wound was dressed. He ate some 
steak, and a poached egg, with potatoes and toast 
this morning. He had a nap from JO to 11 a.m., and 
awoke quite refreshed. 

July 18,8:30 a.m. Temperature 98.4; pulse 88; 
respirations 18. July 18, 1 p.m. Temperature 98.5;. 



36 

pulse 98 ; respirations 18. July 18, 7 p.m. Temper- 
ature 100.7; pulse 102; respirations 21. July 18, 5 p.m. 
The President has suffered from nausea to-day, and 
nourishment was suspended. The wound was dress- 
ed at 6 P.M. and pus came freely from it. July 18, 7 
P.M. The President had more fever this afternoon. 

Bulletin to the consulting surgeons, Drs. Agnew 
and Hamilton : 

July 18, 7 p.m. 
Shortly after our dispatch of yesterday the President 
received a hypodermatic injection of one-eighth of a grain 
of sulphate of morphia. He slept well during the night, and 
this morning had a temperature of 98.4; pulse 88; respira- 
tions 18. His day, however, was not quite so comfortable 
as yesterday. A slight gastric disturbance was noted 
towards noon, in consequence of which the quantity of 
nourishment administered was temporarily diminished. 
This was followed by rather more fever than yesterday, but 
the difference was not great, and is thought to be merely a 
temporary fluctuation. 

(Signed) D. W. Bliss, 

J. K. Barnes, 
J. J. Woodward, 
RoBT. Reyburn. 

July 18, 7 P.M. He received one-eighth of a grain 
of sulphate of morphia hypodermatically, and went 
to sleep soon afterwards. 

July 19, 8 A.M. The President is sleeping soundly 
and quietly. He is sweating, though not profusely. 
This morning he took beef juice and milk with rum 
and one slice of milk toast. As he did not seem to 
relish solid food it was deemed best to give him 
chiefly liquids and in diminished quantities. During 
the morning he seemed quite bright and cheerful, 
and had very little fever. 

July 19, 8:30 a.m. Temperature 98.5; pulse 90; 
respirations 18. July 19, 1 p.m. Temperature 98.5 ; 
pulse 92; respirations 18. July 19, 7 p.m. Temper- 
ature 99.8 ; pulse 96 ; respirations 19. 

Bulletin to the consulting surgeons, Drs. Agnew 
and Hamilton : 

July 19, 7 p.m. 

Last evening the President received a hypodermatic injec- 



37 

tion of one-eighth of a grain of sulphate of morphia, und 
slept vvelldaring the night. He continues to take sulphate 
ot quinia m three grain doses thrice daily, and has enemata 
when required. As anticipated the increased fever of yes- 
terday proved only temporary, and he has had a better day 
to-day than on any day since he was injured. The wound 
looks well, and is discharging healthy pus freely 

(Signed) D. w. Bliss, 

J. K. Barnes, 
J. J. Woodward, 
RoBT. Reyburx. 

July 19, 8 P.M. He received his hypodermatic injec- 
tion of one-eighth of a grain of sulphate of morphia, 
and slept well during the night. July 20, 8 a.m. 
The President's wound was dressed, and it showed 
evidences of granulations. 

July 20, 8:30 a.m. Temperature 98.4; pulse 86- 
respirations 18. July 20, 1 p.m. Temperature 98.4; 
pulse 88; respirations 18. July 20, 7 p.m. Temper- 
ature 99.6; pulse 98; respirations 19. 

July 20, 8 :30 a.m. The President took some milk 
toast and codfish for breakfast this morning. Dur- 
ing the day took some milk and rum alternately with 
Valentine beef juice every two hours. He has also 
had three three grain doses of bisulphate of quinia, 
and three doses of fifteen drops each of aromatic 
sulphuric acid. He passed a comfortable day and 
was quite cheerful, and had scarcely anv evidence 
of fever until about 4 p.m. July 20, 6 "p.m. The 
President's wound was dressed and quite a free dis- 
charge of pus came from it. 

Bulletin to the consulting surgeons, Drs. Agnew 
and Hamilton : 

July 20, 7 p.m. 
During the past twenty-four hours the President's progress 
has been uniform and satisfactory. He had a good night, 
and has expressed himself throughout the day as feeling 
quite comfortable. The indications reported in our last 
telegram have continued without change. 

(Signed) D. W. Bliss, 

J. K. Barnes, 
J. J. Woodward, 
RoBT. Reyburx. 



38 

At 8 P.M. he received his hypodermatic injection 
of one- eighth of a grain of sulphate of morphia, went 
to sleep at 9 p.m. and slept well during the night. 
At 8 P.M. he also received three grains of bisul- 
phate of quinia and fifteen drops of aromatic sul- 
phuric acid. 

July 21. At 8 :20 and 2 :40 a. m. he took some milk 
and rum and afterwards Valentine beef juice. The 
President had a good night, and expressed himself 
as feeling excellently this morning. He took stewed 
chicken and toast for breakfast. July 21, 8:20 a.m. 
Temperature 98.4; pulse 88; respirations 18. 

July 21, 1 P.M. Temperature 98.4; pulse 92; res- 
pirations 19. July 21, 7 P.M. Temperature 99.9; 
pulse 96; respirations 19. July 21. At 10 a.m. he 
took three grains of bisulphate of quinia and fif- 
teen drops of aromatic sulphuric acid. During the 
afternoon he seemed quite tired, though he took a 
fair amount of liquid food. At 6 p.m. his wound 
was dressed and a small portion of the shirt was dis- 
charged from it when it was dressed this morning. 

Bulletin to the consulting surgeons, Drs. Agnew 

and Hamilton : 

July 21, 7 p.m. 
Since our telegram of yesterday the President has con- 
tinued to do well. He passed a comfortable night. This 
morning a morsel of clothing, about one-quarter of an inch 
square, came away spontaneously with the pus from the 
deeper parts of the wound. It proved on examination to 
consist of cotton fibers with a few woolen fibers adhering. 
Medication continued without change. 

(Signed) D. W. Bliss, 

J. K. Barnes, 
J. J. Woodward, 
RoBT. Reyburn. 

July 21, 8 P. M. One-eighth of a grain of sulphate 
of morphia was given hypodermatically. The Presi- 
dent slept well, and took nourishment twice during 
the night. 

July 22, 8 A.M. The President's wound was dressed 
and a large quantity of pus flowed from the wound, 
with a small scale of bone and some fragments of 



39 

clothing and a small slough. July 22, 8:30 a.m. 
Temperature 98.4 ; pulse 88 ; respirations 17. July 22, 
1p.m. Temperature 98.4; pulse 98; respirations 18. 
July 22, 7 P.M. Temperature 100.2 ; pulse 98 ; res- 
pirations 19. 

July 22, 8:30 a.m. The President rested well, and 
took for breakfast milk toast with a little dried beef. 
During the day he took buttermilk alternately with 
milk and beef juice. 

July 22. During the early part of the day the 
President seemed as well as usual ; but became quite 
restless and tired towards evening. At 5 :30 p.m. he 
had an enema, and at 6 p.m. the wound was dressed 
as usual. A free discharge of pus came from the 
wound, but not so abundantly as in the morning. 
During the day he took three doses of three grains 
each of bisulphate of quinia with two doses of elixir 
of gentian and tincture of chlorid of iron, each con- 
sisting of two drachms. He received one-eighth of 
a grain of morphia hypodermatically at 7:15 p.m. 
and soon went to sleep. 

Bulletin to the consulting surgeons, Drs. Agnew 

and Hamilton : 

July 22, 7 p.m. 

The Presideiit rested well last night, and has been easy 
during the day. At the morning dressing the wound, which 
is looking very well, discharged several ounces of healthy 
pus. A little solid fragment that floated out with the dis- 
charge proved to be a thin scale of bone about one-eighth 
of an inch in length, with a morsel of sloughing fibrous 
tissue and a number of adhering fibers of cotton and wool. 
He continues to take and digest a reasonable quantity of 
nourishment. The evening hypodermatic injection of sul- 
phate of morphia (one-eighth of a grain) and the quinia 
(three grains thrice daily) have also been continued. 
(Signed) D.W. Bliss, 

J. K. Barnes, 
J. J. Woodward, 
RoBT. Reyburx. 

July 22, 8:30 p.m. He complained of feeling 
chilly ; this was followed by a febrile rise of tem- 
perature which lasted until 10 p.m. (Temperature 



40 

101.) During the night he was restless and did not 
sleep well. 

July 23, 7 A.M. The President fell asleep towards 
morning, and the dressing of the wound was delayed 
until he awoke. July 23, 7 a.m. Temperature 98.4; 
pulse 92 ; respirations 19. July 23, 10 a.m. Tem- 
perature 101; pulse 110; respirations 24. July 23, 
12 M. Temperature 104; pulse 125; respirations 26. 
July 23, 7 P.M. Temperature 101.7; pulse 118; res- 
pirations 25. 

July 23, 10 A.M. The President was more restless 
last night, but this morning at 7 a.m., while prepara- 
tions were being made to dress his wound his tem- 
perature was found to be normal. At 7 :30 a.m. he 
had a slight rigor, in consequence of which the dress- 
ing of his wound was postponed. Reaction followed 
promptly, and the dressing has just now been com- 
pleted. July 23, 12 M. He is feverish and quite 
restless, and has vomited three times this morning 
a fluid tinged with bile. At the noon consultation 
to-day on account of the unfavorable change that 
has taken place in the symptoms presented by the 
President, it was deemed best to telegraph for the 
can suiting surgeons. This was done accordingly, 
and Drs. Agnew and Hamilton arrived at 8 : 15 p.m. 

July 23, 2 p.m. He has just fallen asleep. He 
slept until 3:45 p.m. 4:40 p.m. Again asleep and 
slept until 5:45 p.m. 6 p.m. He took three ounces 
of milk and one teaspoonful of rum. At about 12 :45 
P.M. the President began to perspire and his tem- 
perature began to fall gradually, until at 7 p.m. it had 
fallen to 101.7. There has been a free discharge of 
pus from the wound during the day. 

At 11:30 P.M. President Garfield had another 
rigor (the fifth he has had since 7 :30 p.m. of July 
22) and afterwards sweat profusely during the night. 



Chapter III. 

Period from July 24 to August 8, 1881. Septic 

Infection Continues — Counter Openings made 

TO Drain Wound August 8, 1881. 

July 24, 8 A.M. The President's skin is drenched 
with a profuse perspiration. His skin is cool, with 
a somewhat anxious expression of countenance. An 
examination of the wound was made by the consul- 
ting and attending surgeons, and a small pus sac was 
found about three inches from the external wound (in 
a downward direction). After consultation it was 
deemed advisable to make a counter opening three 
inches below the wound for the purpose of drainage. 
The skin was sprayed with sulphuric ether to dimin- 
ish the sensibility of the parts, and the opening was 
made by Dr. Agnew assisted by Dr. Hamilton. A 
large drainage tube was tied in communicating with 
both openings. The wound was then dressed, and 
he was given one ounce of Liebig's extract of beef, 
and afterwards three ounces of milk and one tea- 
spoonful of rum. 

July 24, 12 M. The President feels much more com- 
fortable since the operation. His skin is much more 
natural in hue. He is still sweating profusely but 
there is no evidence of rigors. He has vomited once 
slightly this morning, but has taken and retained 
some nourishment. 

July 24,12 m. Temperature 99.8; pulse 118; res- 
pirations 24. July 24, 7 p.m. Temperature 99.2; 
pulse 104; respirations 23. July 24, 5 p.m.. The 
President is much more comfortable to-day than yes- 
terday. He has slept a good deal at intervals during 
the day, and has retained all the beef essence given. 
To-day Professors Bell and Newcomb came to the 



42 

President's room with Mr. Tainter and demonstrated 
the use of the induction balance for discovering 
bullets in the human body. Professor Agnew returned 
to Philadelphia in the 5 :40 p.m. train, but Professor 
Hamilton remained over during the night in Wash- 
ington. July 24, 6 P.M. The wound was dressed, 
and thoroughly washed out with a weak solution of 
carbolic acid (one-fourth of 1 per cent). He received 
a hypodermatic injection of one- eighth of a grain of 
sulphate of morphia at 7 p.m., and slept tolerably 
well during the early part of the night. He vomited 
once at about 10:30 p.m. He took small quantities 
of beef juice and milk during the night. At 3:30 
A.M. he had a profuse sweat. He was rubbed off 
with a solution of alum and then with alcohol. 

July 25, 8 A.M. The President seems quite cheer- 
ful this morning, and takes his liquid food freely 
and with relish. He passed a comfortable night, and 
has had no rigor since yesterday. July 25, 8 :39 a.m. 
Temperature 98.4 ; pulse 96 ; respirations 18. July 
25,12 m. Temperature 98.4; pulse 106; respirations 
20. July 25, 7 p.m. Temperature 101.8; pulse 110; 
respirations 24. At 12 m. he took six grains of quinia 
(bisulphate) and at 3:30 p.m. he complained of feel- 
ing cold. Bottles of hot water were placed at his 
feet, and he was well rubbed. He vomited once, and 
after the vomiting he had a profuse sweat. He was 
quiet but did not take much nourishment during the 
day with the exception of beef essence. He had a hypo- 
dermatic injection of one-eighth of a grain of morphia 
at 7 P.M. He slept for an hour or two, and at 11 :30 
p.m. had another slight rigor. He complained of 
chilliness which was followed by fever and sweat dur- 
ing the night. Professor Agnew arrived at 12 (mid- 
night). The President was somewhat restless during 
the night, and the fever which had subsided during the 
evening rose again about midnight, and continued 
until 3 A.M. after which it again subsided. 

July 26, 8:30 A.M. Temperature 98.4; pulse 102 ; 
respirations 18. July 26, 12 m. Temperature 98.4; 



43 

pulse 106 ; respirations 19. July 26, 7 p.m. Tem- 
perature 100.7 ; pulse 104 ; respirations 22. July 26, 
8 A.M. The President is quiet and does not complain 
of pain. 

•July 26, 8 A.M. The wound was dressed, and Dr. 
Agnew enlarged the opening over the rib, and extracted 
therefrom a fragment of bone, which had been driven 
in by the bullet, and was lying loose in the inner 
track of the wound. Some fragments of muscle and 
connective tissue were also removed. The largest 
piece of bone removed was about an inch in length. 
There were also small particles of bone taken out. 
The wound was well irrigated with the quarter per 
€ent. solution of carbolic acid, and two drainage 
tubes were fastened in the lower wound, one entering 
the cavity, and one draining the lower opening of the 
wound. The President bore the operation remark- 
ably well, and in fact his condition seemed much 
more comfortable after the dressing and operation 
than it was before. 

July 26, 12 M. He took six grains of bisulphate 
of quinia. During the afternoon he had several good 
naps, and took liquid nourishment quite freely. At 
o :39 P.M. the President had a slight sweat. 5 :30 p.m. 
He was given six grains of bisulphate of quinia. 11 
p.m. The President had his hypodermatic injection 
of one-quarter of a grain of sulphate of morphia at 
7:30 p.m.; after a short time he went to sleep and 
slept until 11 p.m. when he awoke, and after a little 
while he went to sleep again, and slept soundly until 

5 A.M. 

July 27,7:30 a.m. This morning he took beef 
essence, and four ounces of koumiss. July 27, 8 a.m. 
Temperature 98.4; pulse 94; respirations 18. July 
27,12:30 p.m. Temnerature 98.4 ; pulse 90; respira- 
tions 18. July 27,7 P.M. Temperature 98.8; pulse 
96: respirations 20. 

July 27,8:30 a.m. The President's wound was 
dressed and looked well. There were no rigors nor 
febrile rise of temperature during the day. He took 



44 

his liquid nourishment freely and without any ap- 
parent disorder of the stomach. He received his 
hypodermatic injection of one-fourth of a grain of 
sulphate of morphia at 7 :40 p.m. and slept well dur- 
ing the night, sleeping at one time three hours with- 
out interruption. 

• July 28, 8 A.M. The President w^as very cheerful 
this morning, and seemed to feel comfortable. July 
28, 8 A.M. Temperature 98.4 ; pulse 92 ; respirations 
18. July 28, 12:30 P.M. Temperature 98.5; pulse 
94 ; respirations 18. July 28, 7 p.m. Temperature 
100.5 ; pulse 104 ; respirations 20. 

Professor Hamilton was present at the morning 
dressing of the wound. During the morning the pa- 
tient took bouillon, beef juice, milk, with an egg 
beaten up in it, and one teaspoonful of rum. At 10 :18 
a.m. he took six grains of bisulphate of quinia. 
During the morning the President's room was thor- 
oughly aired and cleaned, and all the carpets and 
upholstered furniture were removed. He took a good 
deal of liquid food to-day, and had no febrile rise 
until 4 P.M. when he complained of feeling a little 
feverish. The wound was again dressed at 6 p.m. 
and the drainage tube being found to be obstructed 
was removed, and a larger tube inserted. At 7 :40 
p.M.he received a hypodermatic injection of one-eighth 
of a grain of sulphate of morphia, and went to sleep 
at 9 P.M. At 10:30 p.m. he complained of a sharp 
pain over the region of the bladder; this was relieved 
by hot fomentations and he went to sleep again at 
11 :30 P.M. At 11 :30 p.m. his temperature was 99.8; 
pulse 98; respirations 19. 

July 29, 7 A.M. The President slept well, and 
awoke feeling refreshed. The wound was dressed at 
8:15 A.M. and was found to be in an excellent condi- 
tion. He is still taking li'quid food only, consisting 
of milk and egg with a little rirm alternating with 
koumiss and beef juice. July 29, 8:30 a.m. Tem- 
perature 98.4 ; pulse 92 ; respirations 18. July 29, 12 :30 
P.M. Temperature 98.4; pulse 98; respirations 19. 



45 

July 29, 7 P.M. Temperature 100 ; pulse 98 ; respira- 
tions 20. 

July 29, 8:30 a.m. Immediately after the evening 
dressing yesterday the President's afternoon fever 
began to subside. He bore the dressing of his wound 
Avell, and exhibited very little fatigue after its com- 
pletion. 7 P.M. The President has been cheerful 
during the day. His wound was dressed the second 
time at 1 :30 p.m. The febrile rise came on later 
and was not so marked as yesterday. He received 
his usual hypodermatic injection of one-eighth of a 
grain of sulphate of morphia about 8 p.m. and slept well 
during the night taking liquid nourishment at 1, 3 and 

6 A.M. 

July 30, 8 :30 a.m. The slight febrile rise of yester- 
day afternoon had subsided by midnight, and this 
morning his temperature is again normal. July 30, 
8:30 a.m. Temperature 98.5; pulse 92; respirations 
18. July 30, 1 P.M. Temperature 98.5; pulse 98; 
respirations 20. July 30, 7 p.m. Temperature 100.2 ; 
pulse 104; respirations 20. 

July 30, 8:30 a.m. The President slept well until 
8:40 a.m. His wound was then dressed, and found 
to be discharging freely. At 9 :10 a.m. he took some 
rare beefsteak and scraped beef for breakfast, follow- 
ing this with six ounces of koumiss. At 10 a.m. he 
took six grains of bisulphate of quinia. During the 
day he received a good share of liquid food, had sev- 
eral naps, and expressed himself as feeling quite com- 
fortable. A head rest elevating the upper portion of 
his body was placed under the mattress of his bed, 
by means of which his head and shoulders have been 
somewhat raised, and he expressed himself as much 
pleased by the change of position. The afternoon 
rise of temperature was moderate and did not com- 
mence until 5 P.M. Professor Agnew arrived to-day, 
and was present at the evening dressing along with 
Professor Hamilton. (Professor Hamilton has re- 
mained continuously on duty with the attending sur- 
geons since July 27). A small drainage tube was 



46 

passed farther into the cavity of the wound than 
heretofore, and the wound was thoroughly washed 
out with the quarter per cent, solution of carbolic 
acid. He received a hypodermatic injection of one- 
twelfth of a grain of sulphate of morphia, and went 
to sleep at 8:15 p.m. 

July 31, 8 :39 a.m. The President slept well during 
the night, and expressed a desire for solid food. After 
his wound was dressed he took a lamb chop for break- 
fast. Professor Hamilton returned to New York this 
morning while Professor Agnew remained in Wash- 
ington. The afternoon fever of yesterday subsided 
earlier than the night before, and had quite disap- 
peared by JO P.M. 

July 31, 8:30 a.m. Temperature 98.4; pulse 94; 
respirations 19. July 31,12:30 p.m. Temperature 
98.5; pulse 94; respirations 19. July 31, 7 p.m. 
Temperature 99; pulse 104; respirations 20. 

The President bore the morning dressing of his 
wound well. He took and retained an ample supply 
of nourishment to-day, and seems to improve in his 
general condition. An enema was given him this 
afternoon. The wound looks well, and the secretion 
from it is quite abundant. The wound was dressed 
the second time at 6 p.m. At 7 :30 p.m. he received his 
hypodermatic injection of one- twelfth of a grain of 
sulphate of morphia, and slept well during the night. 

August 1, 8 A.M. The President awoke quite re- 
freshed this morning and said he had spent the best 
night since his injury. His wound was dressed at 
8:35 A.M. and quite a free flow of pus came from it. 
After the dressing Professor A. G. Bell and Mr. 
Tainter tried for the second time the induction bal- 
ance, for the purpose of endeavoring to locate the 
bullet in the President's body. This was an appara- 
tus composed of a series of induction coils, so ar- 
ranged that on being brought near a metallic body 
the electric balance would be disturbed, and a sound 
produced. Both Professor Bell and Mr. Tainter from 
these experiments located the ball in a space about 



47 

two inches in diameter, somewhat to the right, and 
four and a half inches below the umbilicus. As will 
be seen hereafter this localization of the bullet was 
an error, and aided in confirming the erroneous diag- 
nosis, which had been previously made by the con- 
sulting and attending surgeons as to the location of 
the bullet. The pus from the wound (though it was 
thoroughly washed out twice, and sometimes three 
times a day, and allowed free exit by means of drain- 
age tubes) gradually formed a sinus or false passage 
in a downward direction from the wound. The trans- 
verse wound through the body of the first lumbar 
vertebra, from its irregular and rough character 
entirely prevented the passage of any probe in that 
direction ; hence from all the means of information at 
our disposal, we were led to the belief that the bullet 
was located in the right side of the abdomen below 
the point of entrance. After the testing of the 
induction balance the President took some beefsteak, 
toast and gravy and a cup of coffee. At 11 a.m. he 
was given six grains of bisulphate of quinia, and 
this dose was repeated at 4:30 p.m. During the day 
the President seemed somewhat tired, and took sev- 
eral naps. He was given the usual amount of liquid 
food including koumiss. He complained during the 
afternoon that the koumiss had seemed to disagree 
with his stomach. Food was withheld from him for 
a short time with the effect of relieving him. 

August 1, 8:30 a.m. After the slight rise of tem- 
perature yesterday afternoon it became normal early 
in the evening,and so continued during the greater part 
of the day. August 1, 8:30 a.m. Temperature 98.4; 
pulse 94; respirations 18. August 1, 12:30 p.m. 
Temperature 98.4; pulse 100; respirations 19. Au- 
gust 1,7 p.m. Temperature 99.5; pulse 104; res- 
pirations 20. August 1, 7 :45 p.m. He received one- 
eighth of a grain of sulphate of morphia hypoder- 
matically, and slept well during the night. 

August 2, a.m. The President slept well until 8 
a.m., when his wound was dressed as usual. A new 



48 

soft long catheter (No. 8) was passed into the open- 
ing of the eleventh rib, and passed downward into 
the abdominal cavity between three and one-half and 
four inches, and allowed to remain. Another drain- 
age tube was put into the external lower wound (the 
one made by the incision) and both were kept in 
place by strips of adhesive plaster. Discharge of 
pus from wound was free. 

August 2, 8:30 A.M. Temperature 98.4; pulse 94; 
resj)irations 18. August 2,12:30 p.m. Temperature 
98.4 ; pulse 99 ; respirations 19. August 8, 7 p.m. 
Temperature 100; pulse 104; respirations 20. 

August 2. The President had an enema at 2:30 
P.M. The wound was dressed at 6 p.m. and he com- 
plained of darting pains during the evening radiat- 
ing from wound. The discharge from the wound 
was quite profuse. He had at 7 :45 p.m. one-eighth of 
a grain of sulphate of morphia hypodermatically, and 
slept well during the night. 

August 3, 8 A.M. The President passed a comfort- 
able night and this morning the long, soft rubber 
tube was removed from the wound (it seeming to 
cause irritation), and a short, wide drainage tube 
was inserted in its place. Dilute solution of perman- 
ganate of potash was used to wash out the wound 
instead of the dilute solution of carbolic acid. The 
strength of the solution of permanganate used was 
eight grains to two pints of water at the temperature 
of 100 F. Professor Agnew (who had been on duty 
with the attending surgeons since July 30) returned 
to Philadelphia at 9 :30 a.m. At 5 :30 a.m. the Presi- 
dent took six ounces of koumiss, at 7 :30 four ounces 
of bouillon and two teaspoonfuls of beef juice, and at 
9 a.m. six ounces of milk and two teaspoonfuls of rum. 
He went to sleep at 9:45 a.m. and slept until 10:45 
A.M. when he took six grains of bisulphate of quinia, 
and the same dose at 5 :40 p.m. At 11 :30 a.m. he break- 
fasted and took a little steak, toast and potato. He 
passed a very comfortable day. The discharge from 
the wound was profuse and laudable in character. 



49 



During the afternoon he had scarcely any pain, and 
his temperature remained normal until the evening, 
when it was one degree above. During the day he 
took a good supply of liquid food. 

August 3, 8 :30 a.m. Temperature 98.4 ; pulse 96 ; 
respirations 18. August 3, 12 :39 p.m. Temperature 
98.4; pulse 100; respirations 19. August 3, 7 p.m. 
Temperature 99.4 ; pulse 102 ; respirations 19. 

He received his hypodermatic injection of one-six- 
teenth of a grain of sulphate of morphia at 8 p.m. and 
went to sleep at 9 p.m. He slept well during the night, 
waking at 3 a.m. for a short time. He then slept until 
8 A.M. of August 4. Professor Hamilton arrived last 
night (August 3) and will remain until Professor 
Agnew returns. August 4. Wound was dressed at 
8 A.M. The drainage tube was removed and a smaller 
tube inserted. Diet the same as yesterday. 12:30 
P.M. He was given six grains of bisulphate of qumia. 
At 12 M. Professor Hamilton made a careful ex- 
amination of the President, and found a small point 
of induration, one and a quarter inches to the left 
of anterior superior spinous of right ilium, and about 
the center of a linedrawn from one anterior superior 
spinous process to the other. The President had an 
enema at 4 p.m. and at 6 p.m. he took six grains ot 
bisulphate of quinia. i on. 

August 4, 8:30 a.m. Temperature 98.4; P^lee 90, 
respirations 18. August 4, 7 p.m. Temperature 100.2 ; 
pulse 102; respirations 19. 

The President passed a good day without draw- 
backs of any kind. He took his nourishment well, 
and has shown little fatigue after his dressings, and 
changes of position. The wound looks well. Ihe 
President took a fair amount of liquid food during 
the day, and went to sleep at 9 p.m. and slept well 
during the night. He received no morphia at bed- 
time to-night. .-,,11. J- n„ 
August 5, 8 :30 a.m. The President slept naturally 
during the greater part of the night, though he has 
taken no morphia for the past twenty-four hours. 



50 

His improved condition warranted several days ago 
a diminution in the quantity of morphia adminis- 
tered hypodermatically at bedtime, and it was re- 
duced at first to one-twelfth, and then to one- sixteenth 
of a grain in the twenty-four hours without any 
unpleasant results, and finally has been altogether 
dispensed with. Yesterday and to-day only two 
bulletins have been issued, in place of three as here- 
tofore. August 5, 8:30 a.m.. Temperature 98.4; 
pulse 88; respirations 18. August 5, 7 p.m. Tem- 
perature 100.4; pulse 102; respirations 19. August 
5, 6 A.M. He took seven ounces of koumiss. At 9 :10 
A.M. seven ounces of milk with two teaspoonfuls of 
rum. At 11 :40 a.m. he breakfasted on toast, beef- 
steak and potatoes in small quantities. At 9 : 30 a.m. 
he was given six grains of bisulphate of quinia. At 
12 M. he took four ounces of koumiss. At 1 p.m. he 
took six ounces of milk and two teaspoonfuls of rum. 
At 3:10 P.M. he had three and a half ounces of 
chicken jelly. At 5 p.m. he took beef juice and 
bouillon, and at 7 :30 p.m. he took six ounces of milk 
and two teaspoonfuls of rum. Wound was dressed 
at 6 P.M. and the discharge was abundant. No hypo- 
dermatic injection of morphia was given this even- 
ing. The President did not get to sleep until after 
9 P.M. and awoke at 11 :15 p.m. for a short time and 
then slept through the night until 6 :30 a.m. August 6. 
August 6, 3 A.M. The President took three ounces 
of Valentine beef juice, and two and a half ounces of 
bouillon. At 7 a.m. he took six ounces of milk with 
two teaspoonfuls of rum. 8 a.m. Dressed the wound 
as usual. The cavity of the wound was measured 
and found to contain two ounces of fluid. To-day it 
was deemed best to suspend the administration of 
the bisulphate of quinia, and to give instead two 
teaspoonfuls of compound tincture of gentian three 
times a day. Claret was also directed to be given as 
a beverage. He took during the morning four ounces 
of the claret. Breakfast consisted of a small quan- 
tity of steak, toast and potatoes. 



51 

August 6, 8:30 a.m. Temperature 98.4; pulse 92; 
respirations 18. August 6, 12:30 p.m. Temperature 
98.5 ; pulse 100 ; respirations 19. 

The President passed a comfortable morning but 
towards the afternoon he complained very much of 
exhaustion from the excessive heat. The external 
temperature was such that it was found impossible 
to keep the temperature of his room below 90 de- 
grees F. without closing the doors and windows, 
which was not thought prudent. During the day the 
President took a good deal of liquid, but scarcely 
any solid food. Towards the afternoon his febrile 
symptoms seemed to become more aggravated, and 
he was greatly exhausted by the evening dressing. 
No quinia was given to-day, and his tongue seemed 
to clear off . At 8 p.m. Professor Agnew arrived. At 
10 P.M. the President took seven ounces of milk with 
three teaspoonfuls of rum. He soon afterwards 
went to sleep, and slept the greater part of the night. 

August 7. From 1 to 5 a.m. the President had a 
-slight febrile rise which passed off by 8 a.m. At that 
hour his temperature was 98.7. At 6 a.m. he took 
six ounces of koumiss, at 8:15 six ounces of milk, 
and two teaspoonfuls of rum. At 11 a.m. he 
breakfasted on a little steak, toast and potatoes. 
At 11:15 A.M. he had four ounces of koumiss. 
At 1 P.M. he had seven ounces of milk. At 3 : 20 p.m. 
he took four ounces of claret. The President com- 
plained so much of the compound tincture of gentian 
that it was stopped, and six grains of bisulphate of 
quinia given instead. The President complained 
to-day of slight chilliness, and of pain in the region 
of the wound and in the limbs. 

August 7, 8:30 a.m. Temperature 98.7; pulse 96; 
respirations 18. August 7, 12 m. Temperature 100 ; 
pulse 104; respirations 20. August 7, 7 p.m. Tem- 
perature 101.2; pulse 104; respirations 20. 

August 7. The President was fairly comfortable 
during the day, although his temperature began to 
rise earlier than yesterday, and rose almost as high. 



52 

At the morning dressing it was found that the 
entrance of wound through the eleventh rib was 
apparently obstructed by the drainage tube with 
accumulation of pus in the cavity of the wound. At 
6 P.M. the wound was dressed as usual. The drain- 
age tube was temporarily removed, and the President 
was placed on his right side for the purpose of pro- 
moting drainage from the wound, for about an hour 
during the afternoon and evening. The President 
passed a quiet night, and slept well without the use 
of any anodyne. The rise of temperature of the 
afternoon subsided during the evening and did not 
recur at any time in the night. 



Chapter IV. 

Period from August 9 to Sept. 10, 1881. Coxtixu- 

AxcE OF Septic Ixfection — Gradual Exhaustion 

OF the Strength of the President — Death 

OF THE President on Sept. 19, 1881, 

(from Secondary Hemorrhage). 

August 8, 6 A.M. He had five ounces of koumiss. 
At 8 A.M. seven ounces of koumiss. At 8 :40 a.m. he took 
five ounces of chiret. August 8, 8:30 a.m. Tempera- 
ture 98.4; pulse 94; respirations 18. August 8, 12 
m. Temperature 100.2; pulse 104; respirations 20. 
August 8, 7 P.M. Temperature 101.2; pulse 108; 
respirations 19. 

The President's wound was dressed at 8 a.m. and 
it being evidently necessary to make a more free 
opening in the wound to facilitate the escape of pus, 
he was etherized this morning, and the operation 
performed. Dr. Reyburn administered the ether, 
and it acted very quickly and pleasantly. The inci- 
sion was extended downwards and forwards, and a 
counter-opening was made into the track of the bul- 
let below the margin of the twelfth rib ; this was done 
by Dr. Agnew. Two drainage tubes were then in- 
serted. The President bore tlie operation well. He 
was given some claret at 12 m. At 1 p.m. he took 
seven ounces of koumiss which he vomited soon after- 
wards. He took no nourishment until 5 p.m. and 
then only small doses of milk and lime water were 
given him during the evening until his stomach 
recovered from the nausea resulting from the ether- 
ization. The wound was dressed as usual at 6 p.m.; 
it looked well, but had a profuse discharge of pus and 
bloody serum. The President slept well during the 



54 



night, but had fever which partially abated towards 
morning. 

August 9, 8:30 a.m. The President has a higher 
temperature than he has had for a number of days 
at this hour of the morning. At 8 a.m. his w^ound 
was dressed, and it was found that the pus was being 
freely discharged through the counter opening made 
yesterday. August 9,8:30 a.m. Temperature 99.8 ; 
pulse 98; respirations 19. August 9, 12:30 p.m. 
Temperature 99.7 ; pulse 104 ; respirations 19. Au- 
gust 9, 7 P.M. Temperature 101.9; pulse 106; res- 
pirations 19. 

Since yesterday afternoon small quantities of liquid 
food given at short intervals have been retained, and 
during the day larger quantities were administered 
without gastric disturbance. He had an enema at 
5 P.M. The wound was dressed at 6 p.m. The track 
of the new wound was found to be closed evidently 
causing some irritation. The President slept well 
(without the use of any anodynes) but sweat a good 
deal during the night, and complained of weakness 
this morning (August 10). Professor Agnew left at 
2 P.M. August 9. 

August 10, 5 :30 a.m. He w^as given five ounces of 
milk with half an ounce of lime water. At 8 a.m. 
the w^ound was dressed, and a profuse discharge of 
pus came from the new opening, which evidently 
relieved him very much. His temperature fell to 
normal this morning. August 10, 8 a.m. Tempera- 
ture 98.5; pulse 104; respirations 19. August 10, 
12:30 P.M. Temperature 98.6; pulse 110; respira- 
tions 18. August 10, 7 P.M. Temperature 101 ; pulse 
108 ; respirations 19. 

August 10,8:15 a.m. He took half an ounce of 
brandy. At 9 a.m. he took breakfast, a little chicken 
toast, potatoes and strawberries. At 11:15 a.m. he 
had half an ounce of brandy. At 12 : 15 p.m. he had 
six ounces of milk with half an ounce of lime water. 
At 3 P.M. he had six ounces of koumiss. At 4 : 15 p.m. 
he had half an ounce of brandy. At 5 : 15 p.m. The 



55 

President has passed quite a comfortable day, and 
had no rise of temperature until the evening". The 
wound was dressed at 6 p.m. and was much improved 
m appearance, and with a free discharge from the 
deeper parts of the wound. He has taken half an 
ounce of brandy four times during the past twenty- 
four hours and an adequate supply of liquid food. 

August 11. The President slept well during the 
night only awaking once. At 4:30 a.m. he had six 
ounces of milk. At 6 :30 a.m. he had six ounces of 
koumiss. At 8 :30 a.m. he had three ounces of bouil- 
lon, and two teaspoonfuls of meat juice. At 10:40 
a.m. he had for breakfast the same as yesterday. The 
wound drained well, and there was not such an accumu- 
lation of pus as usual, in the deeper parts of the 
wound. Granulations are showing themselves on 
the edges of the wound. August 11, 8 a.m. Tem- 
perature 98.5; pulse 104; respirations 19. August 
11, 12:30 P.M. Temperature 98.6; pulse 110; res- 
pirations 19. August 11,7 P.M. Temperature 101.2; 
pulse 108; respirations 19. 

At 12 M. he had six ounces of milk. At 2 p.m. he 
had four ounces of bouillon, and two teaspoonfuls of 
meat juice. At 4:10 p.m. he had six ounces of kou- 
miss. During the day he had four doses (of half an 
ounce each) of brandy, at intervals of four hours. 
The President had an excellent day until 4 p.m. when 
the febrile rise took (101.2). On dressing the wound 
at 6 P.M. the flow of pus not as abundant as usual. 
After dressing the wound the President seemed to feel 
relieved, and fell asleep about 6 p.m. Professor Ham- 
ilton arrived at 10 p.m. 

August 12, 1 :15 a.m. he had six ounces of koumiss, 
and the same at G a.m. At 8 a.m. he was given half 
an ounce of brandy. During the night he was some- 
what restless, and awoke at 5 :30 a.m. After being 
sponged off with alcohol he went to sleep again and 
slept until 7 :30 a.m. At 8 : 40 a.m. he took two ounces 
of bouillon, and two teaspoonfuls of beef juice. He 
breakfasted at 10 :50 a.m. on a raw beef sandwich, 



56 



and milk toast and seemed to enjoy it. No brandy 
was given at noon at the request of Professor Ham- 
ilton. At 1 P.M. he had six ounces of koumiss, and 
at 3 P.M. he had six ounces of milk. At 5:30 p.m. he 
had six ounces of koumiss. Dr. Bliss was compelled 
to go home to-day at 1 :30 p.m. as he was suffering 
from septic poisoning received through a cut in his 
hand while dressing the wound of the President on 
August 8. 

August 12, 8 :30 a.m. Temperature 98.6 ; pulse 100 ; 
respirations 19. August 12, 12:30 p.m. Tempera- 
ture 99.3; pulse 100; respirations 19. August 12, 7 
P.M. Temperature 101,2; pulse 108; respirations 19. 

The President has been doing fairly well to-day, 
though slightly feverish. It was determined to ab- 
stain from giving the President any brandy or other 
stimulants for the term of twenty-four hours. The 
wound was dressed as usual, and the discharge at 
both morning and evening dressings was not as 
abundant as customary. He had the same febrile 
rise (101.2) that he had last evening. 

August 13, 8:30 a.m. The President did not sleep 
as well as usual during the early part of the night. 
After midnight, however, his sleep was more refresh- 
ing, and only broken at long intervals. This morn- 
ing his temperature did not fall to the noi'mal point 
(as it has done for several days past) and remained at 
100.8 during the morning dressing. After the morn- 
ing dressing he improved, and his temperature fell 
to 99.2. August 13, 8:30 a.m. Temperature 100.8; 
pulse 104; respirations 19. August 13, 12:30 p.m. 
Temperature 99,2; pulse 102; respirations 19. Au- 
gust 13, 7 P.M. Temperature 100.7 ; pulse 104 ; res- 
pirations 19. 

August 13, 2 P.M. The fever indicated in the morn- 
ing bulletin has gradually receded and the Presi- 
dent is in good spirits and expresses himself as feel- 
ing very comfortable. The day is extremely oppress- 
ive, over 90 F. in the shade ; but the President's room 
is kept comparatively comfortable by means of the 



57 

cooled air, which is forced into it, the temperature be- 
ing kept about 80 F. Early this morning at 3 a.m. he 
awoke and took six ounces of milk ; at 6 :45 a.m. he 
had six ounces of koumiss ; at 8 a.m. he had three 
and one-half ounces of bouillon, and two drachms of 
meat juice. The stimulants which had been sus- 
pended during the past twenty-four hours were 
resumed to-day. The President showed such exhaus- 
tion after their suspension that the unanimous opin- 
ion of the surgeons was in favor of their resumption. 
Professor Hamilton left for New York at 10:15 p.m. 
At 8 A.M. the President was given half an ounce of 
brandy; at 10:30 a.m. he breakfasted on a little 
stewed dried beef, toast, potatoes and a little onion. 
At 11 a.m. he had six ounces of milk. At 1 :10 a.m. 
he had three ounces of chicken jelly, and half an 
ounce of brandy. At 4 p.m. he had six ounces of milk 
and at 5 p.m. he had an ounce of brandy and three 
grains of bisulphate of quinia. At 5 :45 p.m. he had 
four ounces of bouillon, and two drachms of meat 
juice. The President's wound was dressed as usual 
this morning and evening, and a free discharge of 
pus came from it at both dressings. 

August 14. The President slept fairly well during 
the night, but was slightly feverish, though he said 
that he felt quite comfortable. The morning dress- 
ing seemed to tire him, and there was a good deal of 
irritability of the stomach. At 2:15 a.m. he had six 
ounces of milk ; at 5 a.m. six ounces of koumiss ; at 
8 A.M. half an ounce of brandy in six ounces of milk, 
and three grains of bisulphate of quinia. He break- 
fasted at 10:15 A.M. on a little steak, potatoes, and a 
few blackberries. At 12 m. he was given three grains 
of bisulphate of quinia with half an ounce of brandy ; 
soon after this he vomited. His temperature this 
morning at 8 was one degree less than at the same 
hour yesterday morning. His temperature at the 
evening dressing of the wound was about the same 
as that of last evening. 

August 14, 8:30 a.m. Temperature 99.8; pulse 



58 

100; respirations 18. August 14, 12:30 p.m. Tem- 
perature 99.8; pulse 100; respirations 18. August 
14, 7 P.M. Temperature 100.8; pulse 108; respira- 
tions 19. 

August 14, 12:30 p.m. He was given three drachms 
of beef juice, which he retained. He then went to 
sleep until 3 p.m. when he awoke and shortly after- 
wards vomited. At 5 :30 p.m. he again vomited about 
four ounces of sour liquid tinged with bile. All 
nourishment was suspended, and he was given a tea- 
spoonful of the following mixture in water every 
four hours : 

R Tincture lavandulse comp aa j drachm. 

et tincture cardamoni comp: . . . aa j drachm. 

Acidi carbolic! grs. iv. 

Alcohol : diluti j ss uncias. 

Msce. 

At 9 :45 P.M. he vomited again, and at 9 :50 p.m. he 
was given one drachm of aromatic mixture. At 11 :30 
P.M. he vomited six ounces of greenish biliary fluid. 
He complained of pain in the epigastrium, had con- 
siderable restlessness with fever. His pulse reached 
120 per minute. 

August 15, 3 A.M. The President has awakened at 
intervals of about half an hour, and complains a 
good deal of the pains and distress in the stomach. 
He has retained two teaspoonfuls of milk and lime 
water, which have been given every half hour since 
11 P.M. (of August 14). His pulse is still 120 and 
very weak. After consultation with Drs. Bliss and 
Woodward, Dr. Reyburn gave the President three- 
sixteenths of a grain of sulphate of morphia hypo- 
dermatically. After receiving the injection he went to 
sleep in a short time and slept soundly until 7 :30 a.m. 

August 15, 8:30 a.m. Temperature 100.2; pulse 
108; respirations 20. August 15, 12:30 p.m. Temper- 
ature 99; pulse 118; respirations 19. August 15, 
7:30 P.M. Temperature 99.6; pulse 130; respira- 
tions 22. 

During the morning the President's stomach was 



59 

very irritable, and he was given only three teaspoon- 
fuls of milk and lime water at 7 :30 a.m. which was 
all the nourishment he was able to retain. For the 
irritability of the stomach he was given twelve pow- 
ders each containing one-twelfth of a grain of calo- 
mel with one grain of siibnitrate of bismuth. He 
took one of these every hour until seven were taken. 

The condition of the President at this time excited 
very grave apprehensions in the minds of the attend- 
ing surgeons. His stomach could not as&imilate 
food and just as soon as this occurred he rapidly 
developed symptoms of exhaustion. During the 
afternoon and evening his pulse went up to 130 per 
minute, whilst his temperature kept falling. After 
consultation, alimentation by the rectum was deter- 
mined on, and there is every reason to believe that 
our doing so saved the President from rapidly im- 
pending death. The following was the formula used, 
viz : The yelk of one egg, one ounce of bouillon, one 
and a half ounces of milk, one half ounce of whisky, 
and ten drops of deodorized tincture of opium. Mix 
and administer at the temperature of 100 F. as an 
enema per rectum. The administration of these 
enemas was highly beneficial to the President, and 
he showed the restorative and invigorating effect of 
their use almost immediately. From August 15 
until August 18 he was unable to take any food what- 
ever (except three teaspoonfuls of beef essence) and 
in fact for about one week subsequent to that date 
he was nourished almost exclusively in the same 
way. At 10 :30 a.m. he had nutritive enema (see for- 
mula given above). At 9 : 15 and at 11 p.m. the vomit- 
ing again recurred, and very hot water in teaspoon- 
f ul doses was given ; this seemed to relieve the 
nausea. 

August 16. During the night the President suf- 
fered from nausea until 3 a.m. when a nutritive enema 
was given him, which he retained. After this he 
went to sleep, and slept until 7 :30 a.m. At 8 a.m. 
the wound was dressed as usual. There was a free 



60 



discharge of pus from the wound, and the President 
was much exhausted by the dressing. Had nutritive 
enemas at 3 : 15 a.m., at 8 a.m., at 12 m., at 4. p.m. and 
at 8 P.M. During the afternoon the President reacted 
a good deal, and seemed to be much better. At 5 :30 
P.M. he vomited about three ounces of a greenish 
brown fluid with but little odor. The wound was 
dressed at 6 p.m. It seemed rather dry, but there was 
a fair amount of discharge from it. 

August 16, 8:30 a.m. Temperature 98.6; pulse 110; 
respirations 18. August 16, 12:30 p.m. Temperature 
98.3; pulse 114; respirations 18. August 16, 7 p.m. 
Temperature 98.9; pulse 120; respirations 18. 

August 16, 7 P.M. Temperature 98.9 ; pulse 120; 
respirations 19. 

August 17. At 3 A.M. the President had nutritive 
enema, and again at 8 a.m. He slept well during the 
night, and looks better this morning. August 17, 8 :30 
A.M. Temperature 98.3; pulse 110; respirations 18. 

August 17, 12 :30 p.m. Temperature 98.7 ; pulse 112 ; 
respirations 18. August 17,6:30 p.m. Temperature 
98.8; pulse 112; respirations 18. 

At 10 A.M. he fell asleep, slept soundly and awoke 
refreshed at 11 :15 a.m. He did not vomit during the 
da}^, and the nutritive enemas were well retained, 
and seemed to nourish him sufficiently. Professor 
Agnew has been here continuously on duty since 11 
A.M. of August 14, and as the grave symptoms pre- 
sented by the President seemed to demand the pres- 
ence of all the surgeons, Professor Hamilton was 
sent for and arrived at 10 p.m., August 16. During 
the afternoon a teaspoonf ul of beef extract was twice 
administered by the mouth, and was retained. Small 
quantities of cold water and cracked ice were also 
given without causing nausea. At 12:30 p.m. the 
President was given the nutritive enema; at 12:40 
p.m. one drachm of extract of beef; at 1:45 p.m. an- 
other drachm of extract of beef ; at 5 p.m. a second 
nutritive enema, and at 11 :45 p.m. a third drachm of 
extract of beef. During the day the President seemed 



61 

quite comfortable until about 9 p.m., when he com- 
plained of pain and slight swelling of the right 
parotid gland. The wound was dressed as usual 
night and morning. The inner track of the wound 
seems to be closing up, and the eleventh rib at the 
seat of the fracture is covered with granulations. 

August 18. The President slept well almost all* the 
night, and awoke at 6 :30 a.m. apparently much re- 
freshed. He was then washed and sponged with 
alcohol, and his position changed. During the night 
the swelling of the right parotid gland had increased 
very rapidly, and the following local application was 
applied : 

K . lodoformi 

Et balsam Peru aa drachm i 

Collodii unciam i.' 

Misce. *" 

At 7 A. M. he had nutritive enema, and also at 1 :30 
P.M. At 9 : 30 A.M. he had half an ounce of koumiss, 
and the same at 10 a.m. and at 11 a.m. At 2 :30 p.m! 
he had two ounces of koumiss, and two tablespoon- 
fuls of milk gruel. At 4:30 p.m. he had nutritive 
enema. At 7 p.m. he was given three tablespoonfuls 
of milk gruel and at 11 :30 p.m. he had nutritive 
enema. 

August 18, 8 :30 a.m. Temperature 98.8 ; pulse 104 ; 
respirations 17. August 18, 12:30 p.m. Temperature 
98.4 ; pulse 108 ; respirations 18. August 18, 6 :30 p.m. 
Temperature 100; pulse 108; respirations 18. 

The President asked for and retained several small 
portions of liquid nourishment during the day and 
evening. He bore the evening dressing fairly, but 
complained a good deal of the pain in the parotid 
gland. Professor Agnew left this evening for Phil- 
adelphia. 

August 19. The President was somewhat restless 
and slightly feverish from 10 p.m. last night to 2 a.m. 
this morning. At that hour he began to perspire, 
and then fell asleep, and slept until 7 :30 a.m. At 8 
a.m. the wound was dressed, and the soft catheter 



* 62 

used to wash out the wound was passed along the 
lower track of the wound twelve and a half inches, 
and quite a free discharge of pus came from the 
wound. 

At 7 A.M. he had four ounces of koumiss; at 7 :30 
A.M. nutritive enema; at 8:30 a.m. four ounces of 
koumiss; at 10:15 a.m. two ounces of milk gruel. 
At 11:20 A.M. he began to perspire, having had a 
slight rigor. He was rubbed dry, and wrapped in 
warm woollen cloths, with heat applied to his ex- 
tremities. There is a slight swelling of the right 
side of the face, around the right eye, but the pain 
and swelling of the right parotid gland has much 
diminished. There being a tendency to diarrhea one 
drachm of subcarbonate of bismuth was given to the 
President at one dose. At 1 p.m. he had nutritive 
enema; at 3:30 p.m. three ounces of milk gruel ; at 
4 P.M. six ounces of koumiss; at 6:30 p.m. nutritive 
enema and at 7:20 p.m. three ounces of milk gruel. 
At 7 : 30 P:M. the bowels were moved. 

August 19, 8 :30 a.m. Temperature 98.4 ; pulse 106 ; 
respirations 17. August 19, 2 :30p.m. Temperature 98; 
pulse 106; respirations 17. August 19, 2:30 p.m. 
Temperature 100 ; pulse 106; respirations 18. 

Professor Hamilton left for New York in the 2 :10 
P.M. train to-day. Professor Agnew came from Phil- 
adelphia to Washington to-night (August 19). 

August 20. The President slept tolerably well, but 
wakened several times during the night. He stood 
the dressing of the wound very well this morning. 
The President has slightly relaxed ; he had two loose 
passages, one at 1 a.m. and one at 12 :15 p.m. At 1 :30 
A.M. he had nutritive enema ; at 3 a.m. three ounces 
of milk gruel; at 8:30 a.m. five ounces of koumiss; 
at 10:20 a.m. nutritive enema; at 12:20 p.m. three 
drachms of beefsteak juice; at 2 p.m. three ounces 
of milk gruel ; at 4 p.m. three ounces of koumiss, and 
at 6:30 p.m. three ounces of milk gruel. During the 
day the President took in all nine ounces of milk 
gruel, and eight ounces of koumiss, by the mouth. 



63 

At the morning dressing the wound looked well, and 
the pus was laudable in character. 

After the operation of August 8 the flexible tube 
used to wash out the wound at each dressing readily- 
followed the track of the ball to the depth of three 
and a half or four inches. At the dressings, how- 
ever, a small quantity of pus came, as was believed 
from the deeper parts of the wound, from the part 
of the track beyond the above mentioned point. The 
pus flowed either spontaneously or after gentle pres- 
sure had been applied over the anterior surface of 
the right ilium. This deeper part of the track was 
not reached by the tube until yesterday morning, 
when the separation of a small slough permitted the 
tube to pass downwards and forwards for the dis- 
tance of twelve and a half inches from the external 
opening of the last incision. 

August 20, 6 :oO p.m. The President was somewhat 
exhausted by the evening dressing, and has a little 
more fever this evening. To-day the following oint- 
ment was ordered for application to the inflamed 
parotid gland : 

li . Unguenti belladonnae. 

Iodoform i. 

Balsam: Peruvian, 
^lisce. 

The swelling of the right parotid gland appears to 
be unchanged. 

August 20, 8 :30 a.m. Temperature 98.4 ; pulse 98 ; 
respirations 18. August 20, 12 :30 p.m. Temperature 
98.4 ; pulse 107 ; respirations 18. August 20, 6 :30 p.m. 
Temperature 100; pulse 110; respirations 19. At 10 
p.m. he was given nutritive enema. 

August 21. The President awoke more frequently 
than usual during the night. At 3 :40 a.m. he fell 
asleep, and slept soundly until daybreak. He took 
liquid nourishment in small quantities during the 
night. The wound was dressed as usual at 8 :20 a.m. 
The secretion from the outer surface of the wound 



64 

was rather scanty, and there was not so much secre- 
tion as usual from the deeper track of the wound. 

August 21. At 3 :30 a.m. he was given four ounces 
of koumiss ; at 4 : 60 a.m. three ounces of milk gruel ; 
at 7 A.M. nutritive enema ; at 7 :45 a.m. four ounces 
of koumiss; at 10:10 a.m. three ounces of koumiss; 
at 12 :45 p.m. four ounces of milk gruel. At 1 :30 p.m., 
in endeavoring to hawk up the secretion from the 
right parotid gland, which was very tenacious, he 
brought on an attack of vomiting. At 3:20 p.m. he 
was given the nutritive enema. At 5 : 15 p.m. he vom- 
ited six ounces of biliary fluid of a greenish yellow 
color. The President having vomited three times 
during the afternoon, the administration of food by 
the mouth was temporarily suspended. The parotid 
swelling is painless but stationary. August 21, 8 :30 
a.m. Temperature 98.8 ; pulse 106 ; respirations 18. 
August 21, 12:30 p.m. Temperature 99.4; pulse 108; 
respirations 18. August 21, 3:30 p.m. Temperature 
99.2; pulse 108; respirations 18. 

President Garfield was some of the time entirely, 
and all of the time very largely, sustained by rectal 
feeding from the 14th of August until his death on Sep- 
tember 19. The value of this method of supplying 
waste in grave disease has never been more strikingly 
shown than in this instance, because in all probability 
there was never a patient more closely observed by his 
medical attendants, and because the quantity and 
quality of the rectal diet were most carefully regu- 
lated, both as to mode and time of administration. 
During the stage of inflammation of the parotid 
gland (eight days) this mode of sustenance was 
entirely relied upon, he being unable to take any 
food by the mouth and stomach, and only very small 
quantities of cracked ice and water, which were fre- 
quently rejected. 

The quantities carefully measured, were prepared 
at the dispensary of the Surgeon- General by Hospi- 
tal Steward W. F. Crusor, U. S. A., in accordance 
with the following formula : 



65 

"Beef Extract.— Directions : Infuse a third of a pound 
of fresh beef, finely minced, in fourteen ounces of cold soft 
water, to which a few drops (four or five) of muriatic acid 
and a little salt (from ten to eighteen grains) have been 
added. After digesting from an hour to an hour and a 
quarter, strain it through a sieve and wash the residue with 
five ounces of cold water, pressing it to remove all soluble 
matter. The mixed liquid will contain the whole of the 
soluble constituents of the meat (albumen, creatin, etc.), and 
it may be drank cold or slightly warmed. The temperature 
should not be raised above 100 F. ; as at the temperature of 
113 F., a considerable portion of the albumen, a very impor- 
tant constituent, will be coagulated." 

Two ounces of beef extract, two drachms of beef 
peptonoids, and five drachms .of whisky were given 
with scrupulous regularity every four hours, day and 
night. Occasionally five to fifteen drops of deodor- 
ized tinct. opii were added as an additional nerve 
stimulant and anodyne, and also to secure retention 
of the enema. They were usually retained without 
causing any discomfort on the part of the patient, 
and, as a rule, once in twenty- four hours a discharge 
of healthy feces occurred, generally of such consis- 
tence and form as would justify the belief that diges- 
tion had taken place in the small intestine. For the 
first five or six days the yolk of an egg was added to 
the injections, but in the judgment of the surgeons 
was the cause of annoying and offensive flatus. This 
symptom was promptly relieved by discontinuing the 
egg, and temporarily adding about a drachm of wil- 
low charcoal to the enema. Charcoal tablets by the 
mouth were also occasionally used. 

There was a strong desire on the part of the physi- 
cians to discontinue the use of stimulants, but on 
each occasion when the attempt was made the pulse 
became more frequent and feeble, so that we were 
forced to resume their use. Later in the history of 
the case, after the removal to Elberon, alimentation 
both by the rectum and the mouth was found to be 
borne without evidence of peristaltic antagonism. 

August 22, 8:30 a.m. Temperature 98.4; pulse 104; 
respirations 18. August 22, 12:30 p.m. Temperature 



66 

98.4; pulse 104; respirations 18. August 22, 6:3Q 
P.M. Temperature 100.1 ; pulse 110; respirations 19. 

A feeling of uneasiness prevailed to-day among 
the medical attendants in consequence of the unfa- 
vorable condition of the President. He is greatly 
troubled by the tenacious mucus which accumulates 
in the back of the throat, and in the effort to free 
his mouth and throat he twice brought on attacks of 
vomiting yesterday. Happily after midnight the 
President who had been restless, fell into a sound 
sleep. He slept more quietly during the after part 
of the night, and has been able to retain liquid nour- 
ishment when taken by the mouth, as well as the 
nutritive enemas. During the day there was no 
recurrence of the vomiting and nausea. The parotid 
swelling is not materially smaller but is painless, 
and there is less of the accumulation of mucus in 
the mouth and throat. During the morning he took 
about twelve ounces of milk gruel and koumiss, and 
at 7 A.M. an enema of beef extract was administered.. 
During the day for the first time was noticed a slight 
incoherence of speech, immediately after awaking 
from sleep. This seemed to disappear as soon as the 
senses became fully under control. The heat of the 
weather has somewhat moderated to-day, and it was 
not considered necessary to use the cooling apparatus 
for the President's room. 

August 22, 2 : 10 P.M. The President has passed a 
quiet afternoon, and sleeps a good deal of the time. 
Up to the present time he has taken and retained 
twenty-four ounces of liquid nourishment consisting 
of milk porridge and koumiss. He also continued 
to take at stated intervals small quantities of the 
same kind of food during the evening without dis- 
turbance of the stomach. The wound was dressed 
as usual, and the process of repair seems to be going 
on in all parts of the wound exposed to view. 

August 23, 8:30 a.m. Temperature 98.4; pulse 100; 
respirations 18. August 23, 12:30 p.m. Temperature 
98.9; pulse 104; respirations 18. August 23, 6 :3a 



67 



P.M. Temperature 99.2; pulse 104; respirations 19. 
August 23, 8:30 a.m. The President slept during 
the greater part of the night but awoke at intervals. 
He has taken since last night a larger quantity of 
liquid food by the mouth than in the corresponding 
hours of any day during the past week. During the 
night he received two nutrient enemas, and the use 
of the nutrient enemas was continued at longer in- 
tervals during the day. He continued to take liquid 
food during the afternoon and evening, and had no 
recurrence of gastric disorder. The parotid swelling 
remains unchanged, but the mucus which accumu- 
lates in the back part of the mouth is less viscid, 
and now gives but little trouble. This morning m 
addition to his koumiss and milk porridge, he was 
given the juice of a steak, which he took with relish. 
Professor Agnew, who has remained on duty smse 
August 20, returned to Philadelphia to-day, having 
been relieved by Professor Hamilton. In spite of all 
our efforts to nourish the President he is emaciating 
so rapidlv that it is distressing to look at him. His 
weight when he was wounded was 210 pound^s, and his 
weight now is probably not more than 130 or 135 
pounds. This emaciation is accompanied by such 
great exhaustion as to give rise to the most gloomy 
forebodings on the part of his medical attendants. 
During the last three or four weeks the President has 
often expressed the wish to be in his old home ; he 
longed to be back in Ohio, "on the old sod once more ; 
to walk down the streets of Cleveland, meeting and 
greeting familiar friends." 

August 24, 8:30 a.m. Temperature 98.5; pulse 100, 
respirations 17. August 24, 12 :30 p-^- Temper at^^^ 
99 2 • pulse 104; respirations 17. August 24, 6:30 p.m. 
Temperature 100.7 ; pulse 108; respirations 19. 

August 24 8:30 a.m. The President passed a very 
good night awakening at longer intervals than during 
leveral nights past. He continues to take liquid food 
by the mouth with more relish, and in such quantity 
that the nutritive enemata were suspended tor the 



68 

present. Shortly after the noon bulletin was issued, 
an incision was made into the swelling on the right 
side of the President's face for the purpose of reliev- 
ing the tension of the swollen parotid gland and 
giving vent to pus, a small quantity of which was 
evacuated by the operation. The seat of the incision 
was sprayed with carbolic acid, but no anesthetic was 
given him, and he bore the operation well. He has 
not suffered from nausea to-day. 6:30 p.m. His 
temperature this afternoon is, however, higher than 
yesterday at the same hour, and his pulse somewhat 
more frequent. 

The President continues to be very anxious to 
leave the White House. To-day he asked Dr. Bliss 
if he could be removed by the time cold weather 
came. Dr. Bliss told him he would be removed as 
soon as his stomach was all right. " It's all right 
now," said the President. " I want to get away. If 
we can't go to Mentor, I want to go down the river on 
the Tallapoosa. ^^ (Steamship.) The President slept 
most of the night, but his sleep was broken and dis- 
turbed. Professor Agnew, who had returned to Phil- 
adelphia on the 23rd inst., was telegraphed for, and 
joined in the morning consultation of the 25th. 

August 25. This morning the President is taking 
liquid food in sufficient quantity so that the nutritive 
enemata have not been renewed. August 25, 8:30 
A.M. Temperature 98.5 ; pulse 106; respirations 18. 
August 25, 12 :30 p.m. Temperature 99.2 ; pulse 112 ; 
respirations 19. August 25, 6 : 30 p.m. Temperature 
99.8; pulse 112; respirations 19. 

Many statements having become current to the 
effect that the condition of the President was greatly 
influenced by the miasma generated by the marshes 
which existed south of the White House ; the matter 
was carefully considered by the attending and con- 
sulting surgeons this morning, and they issued the 
following bulletin after the morning dressing of the 
wound : 



69 

August 25, 9 :15 a.m. 
The subject of the removal of the President from Wash- 
ington at the present time was earnestly considered by us 
last night and again this morning. After mature delibera- 
tion the conclusion arrived at by the majority was that it 
would not now be prudent, although all agree that it will be 
very desirable at the earliest possible moment at which his 
condition may warrant it. We are, moreover, unanimously 
of the opinion that at no time since the injury has the Presi- 
dent exhibited any symptoms of malaria. 

(Signed) Frank H. Hamilton, 

D. Hayes Agnew, 
D. W. Bliss, 
J. K. Barnes, 
J. J. Woodward, 
Robert Reyburn. 

A little more pus came from the incision in the 
parotid gland to-day, but the swelling of the gland 
remains stationary. During the past three days the 
President's demands for his removal to some other 
locality have been frequent and almost imperative. 
He is most anxious to go some place, but not to the 
Soldiers' Home. He will not think of that. He has 
been very restless over the subject, and his determi- 
nation to be taken to another place has been the cause 
of much anxiety in the sick room. Upon that sub- 
ject alone he has refused to be guided by his physi- 
cians and friends. He refuses to pay any attention 
whatever to statements that it was impossible to 
take him aw^ay from the White House. After he 
had been told that he could not with safety be re- 
moved, he would not be in the least convinced, but 
would still as earnestly and persistently say that he 
must get away. Mentor is wdiere he specially wants 
to go. Next to that he wants to be taken on board 
the steamer Tallapoosa for a cruise upon the salt 
w^ater. His persistence in this matter may perhaps 
be explained by the fact that whenever he went upon 
a sea voyage he was ahvays greatly benefited thereby. 
At 6:30 P.M. the w^ound was dressed as usual, and no 
unfavorable change has been observed in his condi- 
tion. He has taken by the mouth a sufficient supply 
of liquid food. 



70 

August 26, 8:30 a.m. The President slept most of 
the night, awakening at intervals of half an hour to 
an hour. On first awakening there was. as there has 
been for several nights past, some mental confusion, 
which disappeared when he was fully aroused, and 
occasionally he muttered in his sleep. These symp- 
toms have abated during this morning, as on pre- 
vious days. At present his temperature is slightly 
above the normal, and his pulse a little more fre- 
quent than yesterday morning. 

August 26, 8:30 a.m. Temperature 99.1; pulse 
108; respirations 17. August 26, 12:30 p.m. Tem- 
perature 100; pulse 118; respirations 18. August 
26, 6:30 p.m. Temperature 99.9; pulse 116; respi- 
rations 18. 

After awakening this morning the President's 
mind seemed perfectly clear, and he conversed ration- 
ally with the surgeons about the condition of the in- 
flamed parotid gland. At the morning dressing of 
the President it was observed that pus from the 
parotid swelling had found its way spontaneously 
into the right external auditory meatus, through 
which it was discharging; some pus was also being 
discharged through the incision made over the 
swollen parotid gland, and also into the mouth, 
having dissected its way along the course of Steno's 
duct. 

His wound looks as well as it has done for some 
time past. His pulse and temperature are at the 
present higher than at the corresponding hour for 
some days past. He continues to take by the mouth 
the liquid food, and it seems to be assimilated with- 
out difficulty, nevertheless we can not but regard his 
condition as extremely critical. 

August 26, 6:30 p.m. The President's condition 
has not materially changed since the noon bulletin 
was issued. He occasionally asks for food, and since 
yesterday forenoon, commencing at 11 :30 a.m., the 
nutritive enemata have again been given at regular 
intervals, as a means of administering stimulants as 



well as nutrients. The President seems drowsy and 
slept a considerable part of the day. 

August 27, 8:30 a.m. The President slept from 
half an hour to an hour or more during the night. 
He continues to retain the liquid food given by the 
mouth, and the stimulating enemata; nevertheless 
his pulse has become more frequent since midnight, 
and at 6 a.m. this morning was so flickering and 
irregular that it was impossible to count it. He is 
evidently feebler this morning than yesterday. 

August 27, 8:30 a.m. Temperature 98.4; pulse 
120; respirations 22. August 27, 12:30 p.m. Tem- 
perature 99.6; pulse 120; respirations 22. August 
27,6:30 P.M. Temperature 98.9; pulse 114; respi- 
rations 22. At the morning dressing no material 
change was observed in the wound, and the parotid 
swelling appeared to be in the same condition as 
yesterday. The temperature which was slightly sub- 
normal in the morning, rose a little over one degree 
(Fahrenheit) by noon, and during the morning the 
pulse was somewhat fluctuating. 

August 27, 8 :30 p.m. There was no improvement in 
the condition of the President at the time the noon 
bulletin was issued; during the afternoon, however, 
his symptoms showed a slight amelioration. His 
pulse became less frequent, and his temperature a 
little lower (98.9 F.). The mental disturbance men- 
tioned in yesterday morning's bulletin has disap- 
peared. The parotid swelling has discharged a little 
pus by the opening spontaneously formed into the 
ear as well as by the incision made, but it is not 
perceptibly smaller. The liquid food given by the 
mouth and the enemata continue to be retanied; 
10:30 p. M. The President seems more comfortable. 
This has been a gloomy day at the White House. 
The surgeons and attendants were on duty all night, 
and for almost the first time the President expressed 
himself in terms of discouragement about his own 
case, and inquired anxiously about his symptoms. 
His mind is perfectly clear. 



72 



August 28, 8:30 a.m. The amelioration in the 
President's symptoms announced in last evening's 
bulletin continued during the night, and since mid- 
night some further improvement has taken place. 
The pulse has progressively diminished in frequency. 
The stomach has continued to assimilate the liquid 
nourishment administered, and last evening he asked 
for and ate a small quantity of milk toast. Stimu- 
lating and nutritive enemata continue to be retained. 
There has been no mental disturbance during the 
night or this morning. 

August 28, 8:30 a.m. Temperature 98.4; pulse 
100; respirations 17. August 28, 12:30 p.m. Tem- 
perature 99.5; pulse 104; respirations 18. August 
28,6:30 p.m. Temperature 99.7 ; pulse 110; respira- 
tions 20. 

August 28, 12 :30 p.m. At the morning dressing of 
the President several yellowish points were observed 
just below the ear over the swollen parotid, and an 
incision being made about a teaspoonful of pus es- 
caped. There was also some discharge of pus through 
the two openings (into the ear and the one made by 
the incision) mentioned in previous bulletins. The 
wound looks rather more healthy than it has been 
doing for several days past. Since the morning bul- 
letin there has been a slight rise of temperature 
though but little increase in the frequency of the 
pulse. 

August 28, 6 P.M. The improvement in the Presi- 
dent's condition still continues. He continues to 
take willingly the liquid food given him, and also 
retains the stimulants and nutrients given him by 
enema. His pulse is stronger than it was at the 
same hour yesterday, and but little rise in tempera- 
ture has taken place since noon. 

August 28. This day (Sunday) was intensely hot^ 
the thermometer ranging over 98 degrees F. during 
the entire day, and the cooling apparatus was put in 
operation to the great relief of the suffering Presi- 
dent. This day prayers were offered on behalf of 



73 

the President in all the churches of Washington 
City, and indeed in nearly all the churches in the 
country. During the evening I told him of the pray- 
ers so universally being offered in his behalf. With 
a sad and pathetic smile he answered: "I am glad 
of it; I have need of them." 

August 29, 8:<30a.m. The President's symptoms 
this morning are as favorable as they were yesterday 
at the same hour. Last night was spent much more 
comfortably by the President than the previous one. 
He was restful and there was none of the hacking 
cough that had disturbed him the night before. He 
slept (awakening at intervals) the greater part of the 
night. At these intervals he took and retained the 
liquid nourishment administered. His mind contin- 
ues perfectly clear. 

August 29, 8:30 a.m. Temperature 98.5; pulse 
100; respirations 17. August 29,8:30 a.m. Tem- 
perature 98.6; pulse 106; respirations 18. August 
29,6:30 p.m. Temperature 100.5 ; pulse 110; respi- 
rations 18. 

August 29,12:30 p.m. At the morning dressing 
another small incision was made in the lower part of 
the swelling on the right side of the President's 
face, which was followed by a free discharge of pus. 
A similar discharge took place through the other 
openings. The swelling is perceptibly smaller and 
looks better. The wound remains in an unchanged 
condition, and during the dressing this morning the 
catheter used in injecting and cleansing the wound 
passed downwards to a depth of twelve inches. 
There has been little rise of temperature since the 
morning, but the pulse is more frequent. 

August 29, 6 :30 p.m. The President has been com- 
paratively comfortable during the day. He has 
taken the usual amount of nourishment by the 
mouth, with stimulating enemata at stated periods. 
His rise of temperature this afternoon is one degree 
F. less than yesterday at the same hour, and his pulse 
is less frequent than at noon to-day. The parotid 



74 

swelling has been discharging more freely, and is 
continuing to diminish in size. 

Queen Victoria through Minister Lowell sent on 
Saturday a message to Secretary Blaine saying : "I 
am most deeply grieved at the sad news of the past 
few days, and would wish my deep sympathy to 
be conveyed to Mrs. Garfield." 

August 30, 8:30 A.M. Last night was an unevent- 
ful and quiet one for the President, as he slept the 
greater portion of the night. The rise in tempera- 
ture last night was due no doubt to the accumulation 
of pus in the swollen parotid, and subsided as soon 
as it was evacuated. 

August 30, 8:30 a.m. Temperature 98.5; pulse 
102; respirations 18. August 30, 12:30 p.m. Tem- 
perature 98.9; pulse 116; respirations 18. August 
30,6:30 P.M. Temperature 99.5; pulse 109; respi- 
rations 18. 

August 30, 12 :30 p.m. At the morning dressing 
another small incision was made in the lower part of 
the swelling on the right side of the President's face, 
which was followed by a free discharge of pus. A 
similar discharge took place through the other open- 
ings. The wound in the body remains in an un- 
changed condition. There has been a very slight 
rise in the temperature since the morning dressing, 
but the pulse is more frequent. In other respects 
his condition remains about the same. 

August 30, 6 :30 p.m. The President has had a fairly 
comfortable day. The only solid food given him 
was a little soft milk toast, with occasionally a spoon- 
ful of chicken jelly. He took his liquid food as 
usual with the nutritive enemas. The President 
complained this afternoon of pain in the parotid 
gland, which is discharging freely, and is continuing 
to diminish in size. His temperature this afternoon 
is a degree (F.) less than it was yesterday at the 
same time, and his palse is less frequent than at noon 
to-day. The pus in the track of the wound in the 
body is dissecting its way downwards towards the 



75 

right iliac fossa and a probe can be easily passed 
downwards to the extent of twelve inches. This 
channel was kept free from accumulations of pus by- 
being irrigated with weak solutions of carbolic acid 
or permanganate of potash twice a day ; while doing 
this the catheter was carefully withdrawn so as to 
avoid undue distension of the track of the wound. 

August 31, 8:30 a.m. The President passed a very 
tranquil night. The sensitiveness of the parotid 
gland of which he complained yesterday afternoon 
abated, and he w^as without pain from that cause. In 
addition to the liquid food given him, he received a 
small piece of steak of which he swallowed the juice. 

August 31, 8 :30 a.m. Temperature 98.4 ; pulse 100 ; 
respirations 18. August 31, 12 :30 p.m. Temperature 
98.4 ; pulse 95 ; respirations 17. August 31, 6 :30 p.m. 
Temperature 98.6; pulse 109; respirations 18. 

August 31, 12 :30 p.m. At the morning dressing the 
parotid gland was found to be discharging freely. It 
has materially diminished in size, and the openings 
made in it show evidences of the formation of gran- 
ulations around their edges. 

August 31, 6:30 P.M. The President has passed a 
better day than he has had for some time past. He 
has taken his food with increased relish, and the 
usual afternoon rise of temperature did not occur. 
At the evening dressing the solution of permanganate 
used to wasli out the parotid abscess found its way to 
the mouth, which it did not do this morning, show- 
ing that an opening into the mouth has spontaneously 
occurred. 

During the past two weeks a number of pustules of 
acne, many of which suppurated appeared in the ax- 
illae, and later four or five appeared on the trunk of 
the body; these were about the size of large peas, and 
were opened as soon as they suppurated. These were 
evidently due to the septic condition of the Presi- 
dent's system. The small carbuncle mentioned in 
the report of the autopsy upon the body of the Presi- 
dent was no doubt due to the same cause. The above 



76 



were the only suppurating surfaces, excepting the 
incisions made into the wound, and four small super- 
ficial bedsores formed on the sacrum, which were 
observed on the body of the President during his 
illness. 

Professor Agnew returned to Philadelphia to-day, 
and was relieved by Professor Hamilton. 

September 1. About 9 p.m. last evening the Presi- 
dent became restless and somewhat feverish. His 
pulse was somewhat irregular and fluctuating, and 
varied from 108 to 116 per minute. This condition 
which was unaccompanied by rigors or sweating, had 
subsided by midnight and after that time he slept 
fairly well. 

September 1,8:30 a.m. Temperature 98.4; pulse 
100; respirations 17. September 1, 12 :30 p.m. Tem- 
perature 98.6; pulse 108; respirations 18. September 
1,6:30 P.M. Temperature 99.4; pulse 108; respira- 
tions 18. 

September 1, 12:30 p.m. At the morning dressing 
of the President the abscess of the parotid was found 
to be discharging freely und continuing to diminish 
in size. The state of the wound remains the same. 
His general condition is not materially different from 
what it was yesterday at the same hour, except that 
the pulse is somewhat more frequent. This morning 
in addition to his liquid refreshment he took a little 
beefsteak (swallowing the juice) and some gruel. 

September 1, 6:30 p.m. The condition of the Presi- 
dent has not materially changed since the noon bul- 
letin, except that there has been a moderate rise this 
afternoon amounting to one degree (F). The ques- 
tion of the removal of the President to a more 
salubrious and cooler location was discussed at the 
meeting of the surgeons to-day, but on account of the 
absence of Professor Agnew the final settlement of 
the question was deferred until his arrival, which will 
take place the day after tomorrow. The President 
slept well during the night, and his condition was 
much more satisfactory than during the previous 



77 

night. He waked at intervals, and at such times was 
given more nourishment than usual. There was but 
little fever during the night. The condition of the 
parotid gland and wound remains the same. 

September 2, 8:30 a.m. Temperature 98.4; pulse 
100; respirations 17. September 2, 12:30 p.m. Tem- 
perature 98.7 ; pulse 100; respirations 18. September 
2, 6:30 P.M. Temperature 99.2; pulse 104; respira- 
tions 18. 

Among the many suggestions made respecting the 
removal of the President, one is for his removal by 
the Pennsylvania Railroad to Elberon, and the other 
is for a trip by water on the steamer, Tallapoosa. 

The mails each day bring hundreds of letters con- 
taining all manner of plans for removing the Presi- 
dent, and suggestions as to where he should betaken. 
After the noon examination to-day by Dr. Bliss, Gen- 
eral Swaim, Colonel Rockwell, Ensign Hunt and 
Private Secretary Brown drove down to the Navy 
Yard to inspect the Tallapoosa, and see what quar- 
ters and accommodations there would be for the 
President on board the vessel. 

September 2, 6 :30 p.m. The President passed a com- 
fortable day, and this evening appears to be better 
than for some days past. He has taken a larger quan- 
tity of nourishment than usual, and manifested 
greater relish for it. The parotid gland continues to 
diminish in size. Wound shows no change. 

September 3, 8:30 A.M. The President was some- 
what more restless than usual during the early part 
of the night, but slept better after 1 a.m. This morn- 
ing his general condition does not differ materially 
from what it was at the same hour yesterday, except 
that there is a slight increase in the frequency of the 
pulse. He is a little weaker than yesterday, but other- 
wise there is no change. 

September 3,8:30 a.m. Temperature 98.6; pulse 
104; respirations 18. September 3, 12:30 p.m. Tem- 
perature 98.4; pulse 104; respirations 18. September 



78 

3,6:30 p.m. Temperature 99.6; pulse 102 ; respira- 
tions 18. 

Professor Agnew arrived this morning. There is a 
general agreement among the medical attendants that 
the condition of the President is unfavorably influ- 
enced by the excessive heat of the weather, and by 
the noxious emanations from the Potomac River flats 
immediately south of the Executive Mansion. The 
rank vegetation which fertilized by the city sewerage, 
and stimulated by abundant water and hot sunshine, 
covers these flats during the summer, is now begin- 
ning to decay, and since yesterday morning a faint 
malodorous mist has hung over the river on the south 
side of the Executive Mansion grounds to the Long 
Bridge. The prevailing winds in Washington are 
southerly during the summer months, and these 
winds brought the emanations from the flats (or 
marshy grounds) directly to the windows of the Presi- 
dent's room. The risk incurred in removing the 
President did not seem to the surgeons to be as great 
as it would be if he was retained in his present location 
in the White House. Besides his liquid nourishment 
the President to-day took a'little milk toast, and some 
of the breast of reed birds. His general condition re- 
mains the same as yesterday. After consultation^t. 
was unanimously agreed that the sea voyage on the 
steamer Tallapoosa would not be advisable, i\of likely 
to result in any permanent benefit to the President. 

September 4, 8:30 a.m. The President vomited 
once late last evening, and once an hour after mid- 
night. Notwithstanding this disturbance he slept 
well most of the night, and this morning has taken 
his food without any nausea. His pulse is a little- 
more frequent, but in other respects his condition i& 
about the same as at this hour yesterday. 

September 4,8:30 a.m. Temperature 98.4 ; puis© 
108; respirations 18. September 4, 12:30 p.m. Tem- 
perature 98.4 ; pulse 106; respirations 18. Septem- 
ber 4, 6 :30 p.m. Temperature 99 ; pulse 110; respi- 
rations 18. 



79 

September 4, 6:30 p.m. The President has passed 
a conifortable day. He has taken his food with rel- 
ish, and has had no return of the irritability of 
stomach mentioned in this morning's bulletin. The 
parotid swelling is now so much reduced that the 
contour of the face is restored. The rise of temper- 
ature this afternoon has been very slight, but his 
pulse is more frequent. He seemed more exhausted 
than usual after the dressings of his wound, and is 
perceptibly weaker. He is becoming quite impatient 
in his desire to leave the White House for Elberon. 
The tenacious mucus which has been discharged in 
great quantities from the right side of the Presi- 
dent's mouth has been to him a great source of an- 
noyance and distress. This was coincident with the 
inflammation of the parotid gland, and as it will 
be remembered resulted in the formation of an ab- 
scess, which opened spontaneously, through the 
external auditory canal of the right ear, on August 
26, and on August 31 di«f;harged itself into the 
mouth. During the early stages of the inflammation 
of the parotid there was such rigidity of the mas- 
seter muscle that the jaws were so firmly fixed as to 
preclude the possibility of opening the mouth suffi- 
ciently for satisfactory examination. An interesting 
fact was observed that the inflammation of the 
mucous membrane of the mouth seemed to extend 
by continuity to the mucous membranes of the 
pharynx, larynx, trachea and bronchia. The physi- 
cal signs developed the fact that acute bronchial 
catarrh was the sequel. Hypostatic congestion of 
the lungs was observed for some weeks before the 
President was taken to Elberon, more extensive on 
the right side than on the left, on account of decu- 
bitus. On the right side of the body it extended to 
the sixth rib posteriorly, while on the left side it 
was comparatively slight. 

September 5. The President was restless during 
the early part of the night, but slept fairly well 
after midnight. There was no recurrence of the 



80 

vomiting in the night nor was there any this morn- 
ing. His pulse fluctuated during the night a good 
deal, and he was feverish and restless. In the night 
he commenced talking about the arrangements for 
his removal, and although every effort was made to 
pacify him, he persisted in talking of the matter and 
arranging the details of his departure. Dr. Bliss 
and the other surgeons told him that all arrange- 
ments were being made as rapidly as possible, and 
that as soon as they were completed, they would 
start on their journey. This morning he took beef 
extract and chicken broth for breakfast. 

September 5, 8:30 a.m. Temperature 99.5; pulse 
102; respirations 18. September 5, 12 :30 p.m. Tem- 
perature 99.5; pulse 104; respirations 18. Septem- 
ber 5, 6:30 P.M. Temperature 99.8 ; pulse 108; respi- 
rations 18. 

The first thing the President asked Dr. Bliss this 
morning when he went into his room was : " Well, 
is this the last day in the' White House? " Dr. Bliss 
tried to quiet him, but he said: "No, no, I don't 
want any more delay." About 2 a.m. this morning 
the special train w^hich is intended for the convey- 
ance of President Garfield and the party accompany- 
ing him to Elberon arrived at the Baltimore & Ohio 
depot. It will be composed of an anthracite coal 
burning engine No. 569 (selected on account of its 
absence from dust), President Roberts' special car, 
two Eastlake cars and a baggage car. Car No. 33, 
which is to convey the President, has been thoroughly 
renovated. The seats were all taken out and a false 
top was placed a few inches above the roof of the 
car, in order to give the air an opportunity to circu- 
late between it and the roof, so as to keep the ^ir 
cool. Wire gauze was fastened on the outside of the 
car, completely inclosing the parlor for the Presi- 
dent, thus keeping it free from dust. The inside was 
hung with heavy curtains, and Brussels carpet was 
laid on the floor. The method of removal of the 
President determined on was to take him from the 



81 

White House on a stretcher in a covered wagon to the 
corner of Sixth Street and Pennsylvania Avenue, 
where he will be lifted into the car provided for his 
reception. To make this possible, Chief Engineer 
Walters had on the ground this morning a force of 
three hundred men, who at once proceeded to lay a 
temporary railroad track from the east side of Sixth 
Street to the main railroad track, a distance of over 
three hundred yards. In less than two and a half 
hours the rails were in place, and a train with gravel 
to ballast it was ready to work. Professor Hamilton 
preceded the rest of the party, and went to Elberon 
in advance, so as to have everything ready before the 
President's arrival. Notice has been given to all 
conductors and engineers to be on the lookout for 
the warning of the coming of the Presidential tram. 
Immediately on the receipt of information that the 
train has left Washington, the trains going south on 
the Baltimore & Potomac Pvailroad will be stopped 
or switched off, until the train containing the Presi- 
dent has passed by. It is intended that no noise ot 
nassing trains shall disturb the President, and tor 
that reason trains going in opposite directions will 
wait until the special Presidential tram has passed 
them It having been decided by the surgeons that 
the President should be removed to Elberon, situated 
near Long Branch on the coast of New Jersey, the 
iournev took place to-day. The details as to the 
precautions taken to secure his safe transit were ot 
the most minute character, and every provision was 
made to meet such emergencies as might arise ; even 
to the extent of providing places on the road tor liis 
removal from the train, during the journey, m case 
he should show svmptoms of exhaustion. 

The President was more restless than usual last 
night being evidently excited by the anticipation ot 
th! journey. This morning at 5 :30 a.m his temper- 
ature was 99.8; pulse 118; respirations 18. 

September 6 at 6 a.m. the President was tenderly 
lifted by the devoted friends, who had nursed him 



82 

through his long and weary illness, and in company 
with his physicians, he was carried on a stretcher to 
the outer vestibule of the White House. Twice 
while being carried he waved his hand in recognition 
to those of his household he was leaving behind. 
The bed he had just left had preceded him. He was 
immediately placed upon it without the least appar- 
ent discomfort. The President seemingly enjoyed 
the proceedings until the car was reached. The hour 
was fortunately too early for any great congregatioii 
of people, yet many who had heard of his intended 
removal were present on the streets. In perfect 
silence with men guarding the heads of the horses 
(which by the way, were not attached until the Pres- 
ident was safely in the wagon and were detached the 
moment the car was reached), we slowly wended our 
way to the waiting train. Twelve soldiers grasped 
the wheels of the wagon, as the horses were detached, 
and rolled it to the car containing the bed, to which 
the President was then transferred without the 
slightest disturbance. We left Washington with the 
President at 6:30 a.m. Owing to the admirable 
arrangements of the Pennsylvania Railroad Com- 
pany, and to the ingeniously arranged bed designed 
by Mr. T. N. Ely for the use of the President, he 
suffered comparatively little and bore the fatigue of 
the journey remarkably well. During the journey 
his temperature and pulse were taken occasionally, 
and the effect was noted of the varying rates of speed 
upon the comfort of our patient. The minimum of 
unpleasant motion seemed to be secured when the 
train was going at the rate of sixty miles per hour. 
Through that long hot afternoon no sound of bell or 
steam whistle was heard either from our own, or from 
the large number of trains we passed. It was indeed 
a strange and affecting journey, and as we silently 
sped along it almost seemed as if we were being 
transported by some invisible and noiseless force to 
our destination. At every station we were met by 
silent multitudes, who with uncovered heads greeted 



83 

us, but spoke not a word. The car assigned for the 
use of the party contained besides the President 
Mrs. and Miss Garfield, Mrs. Rockwell and Miss 
Rockwell, Mrs. Dr. Edson, Professor Agnew, Dr. 
Bliss, Surgeon-General Barnes, Dr. Woodward, Dr. 
Reyburn, General Swaim, Colonel Corbin, Colonel 
Rockwell, Secretary Brown and the two family 
servants. 

The President seemed to enjoy the rapidity of the 
motion, and when the train was going at its greatest 
speed of over sixty miles an hour and he was asked 
if the motion was uncomfortable, he smiled and said : 
"Let them go." During the last hour of his journey 
he showed symptoms of exhaustion, which would 
have prevented his making any longer journey, had 
such been required to reach his destination. 

The train reached Elberon at 1.09 p.m. A tempo- 
rary railroad track had been laid from the railroad 
station at Elberon to the Francklyn Cottage which 
had been generously placed at the disposal of the 
President by Mr. Francklyn. On reaching the steep 
grade near the cottage the cars were detached from 
the engine and pushed by hand to the side entrance of 
the cottage, and from thence he was carried to the room 
in which he passed the remaining days of his life. 

September 6,6:30 p.m. During the last hour of 
the journey the President complained a good deal of 
fatigue, and after his arrival was feverish and rest- 
less. At present his temperature is 101.6; pulse 124; 
respirations 18. 

September 6, 10 :30 p.m. The President is sleeping 
quietly, and his fever which was evidently due to the 
exhaustion resulting from his journey, is gradually 
subsiding. 

September 7, 9 a.m. The President slept the greater 
part of the night, awakening, however, as often as it 
was necessary to give him nourishment, which he 
took and relished very well. The fever reported in 
last night's bulletin had subsided by 11 p.m. This 
morning his temperature is normal, and he apjDcars 



84 

to have quite recovered from the fatigue of yester- 
day's journey. At the morning dressing the parotid 
abscess was found to be doing well. The visible part 
of the wound looks somewhat better. 

September 7, 9 a.m. Temperature 98.4; pulse 106; 
respirations 18. September 7, 6 p.m. Temperature 
101; pulse 108; respirations 18. 

The sight of the ocean seemed to give the Presi- 
dent great delight. He said to those about him, "it 
was refreshing to get where he could look at the sea.'^ 
The room where he *was placed is large and hand- 
somely furnished. When the President was taken 
into the room he at once noticed that his bed was so 
situated that he could not look out at the sea. He 
immediately insisted that a change should be made 
in the furniture of the room, by which he would have 
an unobstructed view of the ocean, which was accord- 
ly done. 

September 7, 6 p.m. Notwithstanding the excep- 
tional heat of the weather (the thermometer in his 
bedroom rose to 94 (F) at half past three this after- 
noon) there was a breeze most of the day, so that 
the President was comparatively comfortable. He 
has taken his nourishment regularly, and has slept 
well at intervals during the day. At 12:15 p.m. his 
temperature was 98.4; pulse 114; respirations 18. 
September 8, 8 :30 a.m. The President was restless 
and wakeful during the early part of the night, but 
after midnight slept well until morning. His gen- 
eral condition appears to be more encouraging. 

September 8,9:30 p.m. Temperature 98.7; pulse 
104; respirations 18. September 8, 12 m. Tempera- 
ture 98.4; pulse 94; respirations 17. Septembers, 
6 p.m. Temperature 99.1 ; pulse 100; respirations 18. 
September 8. The President, desiring to diminish 
the number of his medical attendants, Surgeon-Gen- 
eral Barnes, Dr. Woodward and Dr. Robert Reyburn 
retired from the case on the evening of September 7. 
Dr. Bliss remains in charge of the case and the ser- 
vices of Professor Agnew and Professor Hamilton 



85 



are retained as consulting surgeons. The wear and 
tear of the attendance upon the President has been 
perfectly frightful, and was beginning to tell very 
severely upon all the surgeons who had been on duty 
in the case. The constant fever of excitement we 
w^ere under, the continued loss of rest we sustained 
in our endeavors to do all that we could to save the 
President's life, had nearly worn us all out. As 
before mentioned Dr. Bliss never slept a night 
in his own house from the time the President was 
shot until his death (except one night when he was 
compelled to go home on account of an attack of 
blood-poisoning from a cut received during the dress- 
ing of the President's wound). The consulting sur- 
geons were not usually called on for duty at night, 
unless in case of an emergency ; this left the chief 
burden of the night duty upon Dr. Bliss, and in a 
less degree upon Dr. Woodward and myself. Dr. 
Woodward and myself slept alternately one night at 
the White House and the other night at our homes. 
The room the surgeons occupied was immediately 
northeast of the one occupied by the President, and 
we relieved each other, so that he was never without 
medical assistance close at hand. During the latter 
days of the President's illness the weather was ex- 
tremely sultry and oppressive, and after our broken 
rest each nigh't,in the morning we could hardly muster 
energy enough to rise and begin our labors of the day in 
the President's room. It was the custom of Dr. Bliss to 
have brought over from his own house early each 
morning to our room in the White House some excel- 
lent coffee. After we had each drank a couple of cups 
of this strong black coffee, w^e w^ere able to commence 
our day's work. It is probably known to most of the 
profession that all of the surgeons who were on duty 
in the case of President Garfield are dead except my- 
self. It is my firm conviction that the lives of all 
these surgeons were materially shortened by their 
labors in his behalf. Dr. Woodward died a compara- 
tively young man, and every one who knew Dr. 



- 86 

Bliss will agree with me in the opinion that he would 
in all probability be living tc-day if he had never 
taken charge of President Garfield. It was perfectly 
apparent to all the attending surgeons that the Presi- 
dent's life could not be prolonged for more than a 
few days after the date of his trip to Elberon. There 
was a perfect unity of sentiment among the surgeons 
in the feeling that it was our duty to remain and 
minister to the President as long as he desired our 
services, at the sacrifice of our health, or even of our 
lives. When, however, it was deemed best to discon- 
tinue our services, it was with a feeling of the most 
grateful relief that we turned our faces homeward. 
September 8. After the arrival of the President 
at Elberon the following bulletin was issued : 

September 8, 6 p.m. 
The President's temperature was 98.4 ; pulse 94 ; respira- 
tions 17. At the evening dressing, 5 :30 p.m., his temperature 
was 99.1 ; pulse 100 ; respirations 18. He has taken a liberal 
amount of food (both solid and liquid) with apparent relish. 
By special request of the President it has been made our duty 
to say in this public manner,to Surgeon-General J. K. Barnes, 
Surgeon J. J. AVoodward, and Dr. Robert Reyburn that in 
dispensing temporarily wich their services as his medical 
attendants he was actuated only by a wish to relieve them 
from a labor and responsibility, which in his improved con- 
dition he could no longer impose upon them. Both the 
President and Mrs. Garfield desire us to express to these 
gentlemen personally, and in this public manner our high 
appreciation of the great skill and discretion which they 
have constantly exercised as associate counsel in the man- 
agement of his case up to the present time 

(Signed) D. W. Bliss, 

Frank H. Hamilton. 

PRESIDENT Garfield's sojourn at elberon. 
September 9, 8:30 a.m. During last night the 
President was restless until after midnight when he 
fell asleep, and though occasionally awakening for a 
time, yet he slept a good deal. The conditions of the 
parotid gland and wound are improving. The ene- 
mata and stimulants have been suspended "during the 
past thirty-six hours. On the whole, the past twenty- 
four hours give evidence of favorable progress. 



87 

September 9, 8:30 a.m. Temperature 98.4; pulse 
100; respirations 17. September 9, 6 p.m. Temper- 
ature 98.8 ; pulse 100 ; respirations 18. 

A change was made to-day in the watchers upon 
the President ; the four now on duty are Dr. Boynton, 
General Swaim, Colonel Rockwell and Mr. C. 0. Rock- 
well. Two of these will be on duty each alternate 
night, and the day watch will be divided into periods 
of two hours each. The absence of the three surgeons 
who have been relieved from duty in the President's 
case is much felt by the remaining three surgeons, 
who are compelled to sit up with their patient each 
night, and get what chance sleep they can during the 
early morning or evening. This morning though 
cloudy and hazy is comparatively cool and refresh- 
ing. A gentle breeze is blowing from the sea, and 
the day is a decided improvement over the first three 
or four days of the week. The President's cottage 
has been rendered comfortable by fires made in the 
grates, so that no inconvenience will be felt by him 
should the temperature continue to decrease. 

September 9, 1 :25 p.m. The President is now sleep- 
ing quietly. The thermometer at noon registered 75 
degrees ( F). He expressed a desire to see this rnorn- 
ing any of the members of the Cabinet who wished 
to call upon him. 

September 10, 9 a.m. The President slept a good 
deal during the night awakening at intervals of one- 
half to one hour. There is a perceptible increase of 
strength with an improved condition of the digestive 
apparatus. The tumefaction of the parotid gland 
has entirely disappeared, and the suppuration from 
it has greatly diminished. The wound continues to 
improve, and presents a more healthy appearance. 
He takes a fair amount of nourishment, and seems 
to digest it well. The surgeons agreed to allow the 
members of the Cabinet to visit the President, but to 
limit their stay to a few minutes. Secretaries Wm- 
dom and Lincoln are to call this evening. 

September 10, 9 a.m. Temperature 99.4; pulse 



88 



104 ; respirations 18. September 10, 12 m. Temper- 
ature 98.5; pulse 100; respirations 18. September 

10, 6 P.M. Temperature 98.7; pulse 100; respira- 
tions 18. 

The President's condition on the whole is not as 
favorable as it was yesterday. In the morning his 
temperature and pulse were higher but they dimin- 
ished towards evening. 

September 11, 8:30 A.M. Temperature 98.8 ; pulse 
104; respirations 19. September 11, 12 m. Temper- 
ature 100; pulse 104; respirations 20. September 

11, 6 P.M. Temperature 100.6; pulse 110; respira- 
tions 20. 

The daily febrile rise occurred later than usual last 
night, and was prolonged over the greater portion of 
to-day. This was evidently due to a circumscribed 
area of lobular inflammation of the lower part of the 
inferior lobe of the right lung. The portion of the 
lung inflamed is quite limited in extent and the 
inflammation seems to be stationary, as it has not 
progressed during the day. The President's expec- 
toration is more muco- purulent, and is rather scanty. 
No enemata are now given him, as he takes with rel- 
ish a sufficient supply of both solid and liquid food. 
The President is bright and cheerful, and perfectly 
cognizant of all that is going on around him. 

Dr. Bliss took his temperature at about 5 p.m. and 
found it to be a fraction over 100 (F). Dr. Agnew 
examined the President and said he thought the fig- 
ures must be wrong, and requested that another test 
be made. Dr. Bliss replaced the thermometer, aud 
as he did so the President said with a smile : "The 
figures are too high for you, are they? You wish to 
get them lower, if possible, I suppose." 

In addition to his other food he has taken during 
the day three tablespoonfuls of brandy in the shape 
of milk punch. At the evening dressing quite a 
large slough of connective was removed from the 
region of the parotid gland. 

September 12, 9 a.m. Temperature 98.4; pulse 



89 

100 : respirations 18. September 12, 12 m. Temper- 
ature 99.2; pulse 106; respirations 18. September 
12,5:30p.m. Temperature 98.6 ; pulse 100; respira- 
tions 18. 

The President slept soundly last night from 10 p.m. 
to 2 A.M. this morning, when he awoke and took some 
nourishment, and immediately fell asleep and did 
not awake until 4 a.m. At that hour he was sponged 
off, and in the course of a few minutes fell asleep 
again, and did not awake until 7 a.m. at which time 
he apparently felt quite refreshed and rested. The 
suppuration from the parotid gland has almost en- 
tirely ceased, the openings from which the pus dis- 
charged are rapidly healing. The lobular inflamma- 
tion of the lower portion of the right lung (broncho- 
pneumonia) spoken of yesterday seems to be the 
result of the parotid inflammation extending by con- 
tinuity along the mucous membrane of the pharynx, 
larynx, trachea and bronchi. The cough is less to- 
day, and the expectoration has materially diminished. 
The President seems to feel better to-day ; he has taken 
an ample supply of food without discomfort, and has 
had several refreshing naps. His situation, however, 
is considered sufficiently grave to cause a postpone- 
ment by the members of the Cabinet of their pro- 
posed trip to the White Mountains. Postmaster- 
General James goes to New York this morning, but 
will return this evening. 

September 13, 8 :30 a.m. Temperature 99.2 ; pulse 
100; respirations 20. September 13, 12 m. Temper- 
ature 98.8; pulse 100; respirations 20. September 
13, 5 :30 p.m. Temperature 98.4 ; pulse 100 ; respira- 
tions 20. 

The President passed a good night, sleeping most 
of the time. At 10 a.m. this morning the President 
was lifted from his bed to a reclining chair which he 
occupied for half an hour. He said: "This is 
delightful; it is such a change." He was placed in 
a position commanding a full view of the ocean, and 
his body raised to an angle of forty-five degrees. 



90 

During the morning his pulse was irregular, and 
varied a good deal, but when he became quiet, settled 
down to the figures of the morning bulletin. The 
atmosphere is clear to-day, and the weather is cool 
and refreshing. The President is expectorating a. 
good deal of muco-purulent material, and in his con- 
dition of great weakness he becomes much exhausted 
in his efforts to clear his throat of this tenacious mat- 
ter. During these paroxysms of coughing his 
breathing becomes very rapid, and his pulse much 
accelerated. General and Mrs. Grant w^ere here 
to-day, and in the evening General Grant spent some 
time in conversation with the surgeons^ anxiously 
inquiring concerning the exact condition of the Pres- 
ident. 

September 14, 8:30 a.m. Temperature 98.4; pulse 
100; respirations 19. September 14, 12 m. Tem- 
perature 98.8; pulse 104; respirations 20. Septem- 
ber 14, 5:30 P.M. Temperature 99.2; pulse 112; 
respirations 21. 

The President passed a quiet night, sleeping com- 
fortably the greater portion of the night. The day 
is bright and cheerful, and the President i^ in good 
spirits. In addition to the usual nourishment given 
him he ate a little fruit for breakfast. Soon after 
the morning dressing Secretary Lincoln was admitted 
to the sick room. He had not seen the President 
since the afternoon of the day on which he was shot, 
and was greatly distressed by his emaciated appear- 
ance and exhaustion. Drs. Bliss and Hamilton have 
decided on account of the great weakness of the 
President not to transfer him to the invalid chair 
unless he specially requests it. The President said 
just now, " that yesterday's experience at the window 
where he could see the green grass, the soldier walk- 
ing his beat, the men and women in the summer 
house and walking along the beach, the fishermen at 
sea, the vessels on the ocean, and the bathers in the- 
surf made him feel for the first time since he was- 
shot that he was himself again." 



91 

Five pustules of acne have appeared upon the back 
of the President, and were opened to-day. This gave- 
him much relief as they were quite an annoyance to 
him. September 14, 12 :30 p.m. At the urgent re- 
quest of the President he has been transferred from 
his bed to the reclining chair and is enjoying the- 
scene very much. The weather continues very pleas- 
ant and invigorating, the atmosphere is perfectly 
transparent excepting over the ocean, where there is- 
a beautifully tinted haze prevailing. After he had 
comfortably settled down in his chair he expressed 
his sense of gratification, and remarked: "This, 
should have been commenced three weeks ago." He 
remained in his chair about an hour and a half, and 
slept a portion of the time. He did not seem spe- 
cially fatigued by the transfer or change of position 
though he had a slight febrile rise of temperature 
during the evening. 

September 15, 8:30 a.m. Temperature 98.4; pulse 
104; respirations 20. September 15, 12 m. Temper- 
ature 98.9; pulse 102; respirations 21. September 
15,5:30 P.M. Temperature 99.2; pulse 104; respi- 
rations 21. 

The President slept until 3 a.m. when he was wake- 
ful for a period of two hours, during which time his 
pulse rose to 120 per minute, but without the marked 
elevation of temperature which has characterized the 
febrile disturbances hitherto. After this time he 
slept quietly until morning. He had tv,'0 rigors dur- 
ing the night. He expectorates a good deal, and is 
considerably exhausted by his paroxysms of cough- 
ing. His voice is weaker this morning, but he per- 
sists in talking, and thinks he is improving. He 
shows as much anxiety to know what the daily bul- 
letins say concerning his condition as the general 
public does, and comments upon them, and discusses 
his general condition. Dr. Bliss took the 11 a.m. 
train for New York to-day, and will return at 5 p.m.. 
and be present at the evening dressing of the wound. 
This is the only time since the President was shot 



92 

that Dr. Bliss has been absent from his patient for 
any length of time. Drs. Agnew and Hamilton re- 
mained in charge of the President during his absence. 
Dr. Bliss said on his return : " Mr. President, I have 
been away for a few hours as you know, but they 
seemed like an age." Pie replied, "Doctor, you plainly 
show the effect of all this care and unrest, and I am 
glad you were forced to take this temporary relief. 
Your anxious watching will soon be over." 

While the temperature of the President is not 
high this evening (99.2) yet the increasing frequency 
of his pulse and respirations, and more than this the 
excessive exhaustion he displayed, were sure tokens 
that the end of the weary struggle was near at hand. 
During the morning he took his liquid food and a 
small portion of steak. While his mind is usually 
clear, yet on first awakening from a sound sleep, he 
wanders a little for a short time. 

September 15, 6 p.m. The President has passed the 
day quietly, sleeping a little, and coughing occa- 
sionally, the expectoration being purulent. He was 
placed on his reclining chair for three-quarters of an 
hour, and seemed to enjoy it very much. 

September 16, 8:30 a.m. Temperature 98.6; pulse 
104; respirations 21. September 16, 12 m. Tem- 
perature 99.8; pulse 116; respirations 21. Septem- 
ber 16, 5:80 p.m. Temperature 98.6; pulse 104; 
respirations 21. 

The President's condition causes a general feeling 
of despondency. During the past forty- eight hours 
he has made no favorable progress, and during the 
last twenty-four hours there has been a perceptible 
loss of strength. The process of repair in the wound 
has come to a standstill, and the discharge from it 
is thin and watery, and is small in quantity. The 
amount of lung tissue involved is considerably 
greater than it was forty-eight hours ago, and he is 
expectorating considerable quantities of purulent 
material. His attacks of coughing do not recur as 
frequently as they did a few days ago, but are more 



93 

severe and exhausting. The febrile rise during last 
night was not as high as it has usually been lately, but 
the pulse was quite frequent, at one time reaching 
180 per minute. Three small bed-sores which had 
been previously healed have again made their appear- 
ance owing to the President's debilitated condition. 
His mind is not so clear to-day, and he shows evi- 
dences of hallucinations. A slight febrile rise oc- 
curred at 11 A.M. which had entirely subsided by 2 
P.M. Nourishment and stimulants were given him 
freely during the day. Owing to the unfavorable- 
news concerning the condition of the President, 
Postmaster- General James, Secretaries Hunt and 
Windom with their wives are now on their way from 
Boston to Elberon. 

September 17, 8:30 a.m. Temperature 99.8; pulse 
108; respirations 21. September 17, 12 m. Tem- 
perature 102.2 ; pulse 120; respirations 24. Septem- 
iDer 17, 5:30 p.m. Temperature 98; pulse 102; res- 
pirations 24. Up to midnight last night the condi- 
tion of the President had not improved. At 11 p.m. 
his pulse was 130 per minute, and it varied from 116 
to 130 during the night. At about 3 a.m. he fell asleep 
and slept until 6 a.m. When he awoke his pulse had 
receded to 106, and his temperature to 98 (F). Hi& 
temperature during the night did not vary much from 
the normal point. He slept fairly well. in the night 
taking nourishment at proper intervals. At 11 :30 
A.M. he had a severe chill lasting about half an hour, 
and his pulse ran up to 137, followed by perspiration. 
After 12 m. the temperature gradually fell with di- 
minished frequency of pulse and respiration, so that 
they were nearly normal by 6 p.m. He slept most of 
the afternoon, and took liquid nourishment. The 
paroxysms of coughing were less frequent than usual. 
During a lucid interval last night the President 
called Dr. Agnew to him and said: "Doctor, am I 
not critically ill?" "Your condition is critical," wa& 
the frank response, "I thought so," rejoined the 
President. At the time when the President was at- 



94 

tacked with the chill, he complained of very severe 
pain in the anterior mediastinum ; this pain recurred 
at intervals of six or seven hours until the President's 
death. This pain is now believed to have been due 
to the rupture of the aneurismal sac developed on 
the splenic artery, as show by the postmortem. 

September 18,8:30 a.m. Temperature 98; pulse 
102; respirations 18. September 18,11 a.m. Tem- 
perature 100; pulse 116; respirations 20. Septem- 
ber 18, 5:30 P.M. Temperature 98.4; pulse 102; 
respirations 20. 

There was no perceptible febrile rise in the tem- 
perature of the President during the night, the pulse 
ranging from 102 to 112 per minute. The cough 
was less troublesome than on previous nights, and 
the expectoration is unchanged. He was able to 
take the nourishment and stimulants required, with- 
out gastric disturbance, and there was no evidence of 
mental aberration during the night. This morning 
his temperature was six-tenths of a degree (F.) below 
the normal point, and he was immediately sponged 
with hot alcohol and wrapped in hot blankets. Ene- 
mata containing defibrinated beef blood and stimu- 
lants have been administered to him to bring about 
reaction. 

September 18, 6 p.m. The President though quite 
weak has passed a very quiet day. Thiere has been 
no recurrence of chill or mental disturbance during 
the day. At 9 a.m. a slight febrile rise took place 
which began to subside at 11 a.m. 

September 18. To-day the President called Col- 
onel Rockwell to him and said : "Do you think my 
name will have a place in human history?" The 
Colonel answered : "Yes, a grand one, but a grander 
one in human hearts. You must not talk in that 
way. You have a great work yet to perform." After 
a moment's silence he said, sadly and solemnly : 
"No, my work is done." 

September 19, 8 a.m. Temperature 98.8; pulse 
106; respirations 22. September 19, 12:30 p.m. 



95 



Temperature 98.2; pulse 104; respirations 20 Sep- 
tember 19 6 P.M. Temperature 98.4 ; pulse 102 ; res- 
pirations 18. ' 

The President's condition continues to be very 
unfavorable and the end is evidently approaching 
last. Shortly after the issue of last evening's bulle- 
tin, he had a chill lasting fifteen minutes. The 
tebrile rise which followed lasted until midnight dur- 
ing which time his pulse ranged from 112 to 130 per 
minute The sweating which followed was quite pro- 
tuse The cough which was troublesome during the 
chill gave him little annoyance during the remainder 
of the night. At 8:30 A.M. another chill came on 
on account of which the dressing of the wound was 
temporarily postponed. He slept most of the morn- 
ing, coughing but little and with more ease 
_ September 19, 11 :30 p.m. After the evening bulle- 
tin was issued at 5:30 p.m. the condition of the Pres- 
ident remained about the same as during the after- 
noon, the pulse varying from 100 to 106 per minute, 
and with rather increased force and volume. After 
taking nourishment he fell into a quiet sleep. About 
thirty-five minutes before his death, and while he 
w^as asleep, his pulse rose to 120. 

September 19, at 10 p.m. General Swaim who was 
watching m the room with the President heard him 
gasp, and make an eifort to speak. He at once arose 
and came to his bedside. He stood there for a few 
moments looking at him as he apparently lay asleep. 
The President opening his eyes saw and recognized 
him and said : "Weil, Swaim," and then immediately 
afterward, "Oh my! Swaim, what a pain I have right 
here," putting his hand to his heart. General Swaim 
leaned over and felt his pulse, and then finding 
himself unable to count its beats, sent instantly for 
Dr. Bliss, who was in the next room. It required 
but a glance to see what was coming. Death was at 
hand. Dr. Bliss sent immediately for Drs. Agnew 
and Hamilton, and called Mrs. Garfield, who was in 
the adjoining room. Within half a minute Mrs. 



96 

Garfield entered the sick chamber. Nothing was 
said but the one question she addressed to Dr. Bliss, 
"Is there no hope?" "Madame," replied the Doctor 
gravely, "he is dying." 

By this time Mrs. Rockwell and Miss Rockwell, 
Miss Garfield, Private Secretary Brown, Colonel 
Rockwell and Dr. Agnew had entered the room. Mr. 
John Ricard, Mr. H. L. Atchinson and the four attend- 
ants were also present. The President was quite 
unconscious. His eyes were half closed, and the 
balls of them turned upwards, so that the lines of 
white showed between the half-opened lids. There 
was no sound in the sick room except his breathing, 
which at times was loud and stertorous, and then 
again could scarcely be heard. It was not many 
minutes (at 10:35 p.m.) before the life went out so 
gradually that it was hardly manifest w^hen he was 
dead. When the limbs had assumed that eternal 
rigor which only decay can change. Dr. Bliss tried 
to feel the pulse, and endeavored in vain to hear the 
heart beats, and then said in a half whisper, "It is 
over." 



Chapter V. 
Causes of the Death of President G-arfield. 

It is surprising, considering the large amount of 
medical literature in existence devoted to the case of 
President Garfield, to find so many members of our 
profession having very vague ideas concerning the 
cause of his death. 

The immediate cause of his death was the spontan- 
eous rupture of a traumatic aneurism formed on the 
splenic artery, probably as the result of the abrasion 
of the outer coats of this bloodvessel by the bullet at 
the time of the shooting. This was a complication 
that could neither be foreseen or prevented, nor could 
it have been relieved by any exertion of surgical or 
medical skill on the part of his surgeons. The 
proximate cause of his death (and one that would 
have inevitably soon terminated his life even had the 
bursting of the aneurism not taken place) was the- 
profound condition of septic poisoning (septicemia) 
which existed in the case of the President for a con- 
siderable time previous to his death. The initial 
point of this septic condition probably dates as far 
back as the period of the first chill (July 23)^ 
and though there were apparent symptoms of 
convalescence at various times, yet the course of 
this septic infection was practically continuous, 
and could only result in inevitable death. This 
brings up the grave and momentous question for 
consideration viz : Could this septic condition in 
the President have been prevented by a different 
method of treatment on the part of his surgeons? It 
is useless for me to tell how many weary days and 
wakeful nights I have spent in arguing with myself 
the various and opposing arguments on either side 



93 



of this question. In order to give a calm and 
unbiased judgment in this matter, let us go back a 
little and study the course of the missile in the body 
of the President with the nature of the injury pro- 
duced by it. 




Fig. 1.— Lateral yiew (right side) of bodies and spinous processes of 
twelfth dorsal and first and second lumbar vertebrae of President Gar- 
field, showing wound of entrance in body of first lumbar vertebra. 

The bullet from the pistol of the assassin entered 
his body in a horizontal and slightly downward 
direction immediately over the eleventh rib about 
three and one-half inches to the right of the verte- 
bral spine. Its course was deflected downward and 
.somewhat to the left, and then it passed to the left, 
fracturing the eleventh rib; then it fractured the 
twelfth rib at a point slightly more to the left 
than the fracture of the eleventh took place, being 
«till more deflected to the left by the rounded and 



99 



curved surface of the twelfth rib. it then entered 
the upper part of the right side of the body of the 





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first lumbar vertebra, involving the inter-vertebral 
cartilage of the vertebra above (twelfth dorsal) in 
its course. The bullet emerged from the left side 



100 



of the body of the first lumbar vertebra at a lower 
point down than its point of entrance, and continu- 
ing its course to the left with diminishing velocity, 
passed behind the pancreas to a point just below its 
lower surface where it was found at the time of the 








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postmortem examination. The course of the bullet 
was wholly without the peritoneal cavity. 

As will be seen by the engraving, the course of the 
missile after it entered the body of the President fol- 
lowed the line of an irregular, nearly S-shaped curve 
with its convex surface directed to the back of the 



101 

President, and passing to the left and gradually down- 
ward to its termination. A consideration of this fact 
will show at once how impossible it was to obtain any 
information concerning the course of the bullet, or 
its location in the body by any examination made 
from the outside of the body. No probe could be 
passed through the wound in the body of the verte- 
bra, (even if it had been considered advisable to 
attempt such a proceeding), and the purulent mate- 
rial formed in the w^ound as the result of, bacterial 
action, gradually by the action of gravity dissected 
its w^ay dow^nw^ard toward the right iliac fossa, and 
formed a false channel or sinus, which misled the 
surgeons, and made them suppose the bullet lay in 
that part of the body. The carious condition of the 
body of the first lumbar vertebra found to exist at 
the time of the postmortem w^as quite sufficient to 
account for the septic condition of the President 
during life. It may here be remarked that the 
spinal canal of the first lumbar vertebra was not 
opened by the bullet in its course through the body, 
nor were there any gross anatomical lesions found 
in the spinal cord at the time it was examined. It 
should be remembered, how^ever, that the weapon 
with which the President was shot was an English 
revolver of what is commonly called the "bulldog 
pattern," that was capable of throwing a bullet with 
great propulsive force ; and crushed and splintered 
the porous cancellated bony tissue in its passage 
through the body of the vertebra. 

The lacerated condition of the cancellated struc- 
ture of the first lumbar vertebra doubtless con- 
tributed largely to the production of the septicemic 
condition, which was in no wise due to lack of 
proper or sufficient drainage. More favorable 
circumstances for its production than existed m 
the comminuted and softened cancellous tissue, 
with its open venous sinuses bathed m ichorous 
pus could scarcely be imagined. Dr. William White 
(-Review of some of the more Important Surgical 



102 



Problems of President Garfield's Case," p. 15, 1882) : 
"The fact that drainage was thorough and com- 
plete, and that no portion of the unfavorable symp- 
toms was due to failure in this respect, was fully 







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established by the absence of purulent collections, 
either along the track of the ball or in the passagj 
caused by the burrowing of the pus. There was no 
time previous to the first operation (July 24) at 



10-6 

which the accumulated pus did not pass freely out 
ot the original wound. Its exit was favored by grav- 
itation after the two incisions had been made' which 
brought the external openings to a lower level and 
enabled them not only to drain the lumbar and'iliac 
regions but also to carry away any discharge that 
might have come from the fractured vertebra." Anti- 
septic treatment was employed throughout the case 
as carefully as it was possible to do so, and drainage 
tubes were used until it was evident that their use 
was unnecessary." 

^ In attempting to reply to the above mentioned ques- 
tions, much time and labor have been spent in review- 
ing the various authorities on this subject. The con- 
sensus of opinion of all the great masters of the art 
of surgery is to the effect that these injuries are 
almost necessarily fatal. Dr. Lidell, justly esteemed 
as one of our most experienced of American military 
surgeons, says {American Journal of the Medical 
Sciences, Vol. 48, p. 317) : "Leaving out of the calcu- 
lation such fractures as involve the spinous processes 
alone, the writer has never seen a case of gunshot 
fracture get well, and he might add that he has 
never seen life prolonged for a month after the inflic- 
tion of that injury." 

In Circular No. 6, Surgeon-General's Office, 1865 
(is^sued during our Civil War), it is reported that of 
187 recorded- cases of gunshot fracture of the verte- 
brae, all but seven proved fatal ; six of these were 
fractures of the transverse or spinous apophyses. It 
is well known that fractures of the vertebral pro- 
cesses are not especially fatal injuries, and that a 
large proportion of them recover. Many of these 
have been recorded under the general head of frac- 
tures of the vertebrae, but evidently have no bearing 
on the case in question. Dr. Demme, ("Military 
Surgery," 1868) says: "Extensive injuries or lodg- 
ment of balls in vertebrae or in the cord give rise to 
death or incurable paralysis." 

Professor Gross ("Treatise on Military Surgery," 



104 



Vol. 2, p. 82) says: "Gunshot wounds of the verte- 
bra3, with lesion of the spinal cord, are nearly always, 
if not invariably fatal. Of twenty-two cases of this 
kind in the English army in the Crimea, not one 







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recovered. Even when the bones alone are affected 
the danger is generally very imminent, most of the 
patients thus affected dying in a short time." 

Professor P. S. Connor (Ashhurst's International 
Encyclopedia of Surgery, 1882, Vol. 2, p. 203) says: 



105 

"The prognosis of vertebral injuries, aside from the 
less severe forms of contusions and fractures of the 
processes, especially the spinous, is very grave, death 
usually resulting from lesion of the cord, from sep- 
tic infection, from caries with abscess, or from asso- 
ciated wounds of a viscus or large vessel. As was 
declared by Ollivier, in gunshot cases the accidents are 
graver and death generally more rapid than in those 
otherwise caused. Of the thirty- two cases of verte- 
bral fracture among the British soldiers in the 
Crimea, all proved fatal except four, which were 
either fractures of the transverse processes in the 
neck, or of the spinous processes only, and in the 
French army, 181 died out of 194 (93.3 per cent.). 
In the war between Prussia and Hanover in 1866, 
there were eight cases with six deaths. Of 628 cases 
tabulated by Otis, 349 or 55.57 per cent, ended in 
death, the mortality according to locality having 
been : For the cervical region 70 per cent. (63 out of 
90) ; for the dorsal region 63.5, (87 out of 137) ; and 
for the lumbar region, 45.5 per cent. (66 out of 145) ; 
but in almost all probably, of the non-fatal cases, 
the fractures affected only the processes." 

In the Wien Medicin Wochen, No. 47, 1881, Pro- 
fessor Max Schuller, after giving a complete history 
of President Garfield's case concludes as follows : 
''Taking into consideration all the circumstances 
connected with this gunshot wound, it is evident 
that the determination of the direction taken by the 
missile by probing would have been extremely diffi- 
cult, and had it been possible, would have been 
accompanied by great danger to the patient. Among 
the symptoms which presented themselves immedi- 
ately after the receipt of the injury, only the pain 
and disturbance of insensibility in the lower extrem- 
ities, gave an indication of the true course of the 
bullet. If, however, the supposition had been enter- 
tained that the vertebral column was wounded, the 
question of the indication for treatment would not 
have been different from that instituted by the 



106 



attending surgeons." He then continues : "To pre- 
vent sepsis in gunshot injuries, and to bring to a. 
successful issue such a wound as that received bv 



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Diagram of posterior surface of body of President Garfield. 1. Point 
ot eiiti aiice of bullet. 2. Location of bullet when found during the post- 
mortem examination. ^ 

President Garfield, is one of the most difficult achieve- 
ments, and can not always be accomplished, even 
with the most careful and assiduous application of 
aseptic surgery." 




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107 

Dr. John Ashhurst (No/^th American Revieiv, Decem- 
ber, 1881, p. 594) says: "Looking at the whole case 
from beginning to end, I do not see that the treat- 
ment could have been altered in any way to the 
advantage of the illustrious patient ; nothing was 
done that should have been omitted, and nothing 
was left undone that could possibly have been of 
benefit." 

Dr. J. Marion Sims (North American Revieiv, De- 
cember, 1881, p. 300) says : "The President's sur- 
geons did all that men could do, all that the present 
state of science would permit, and all that could 
have been done, even if they had first ascertained the 
course and direction of the ball." "Our whole med- 
ical literature does not contain a single well authen- 
ticated case of recovery from such a wound." "He 
had not the least chance of recovery under any 
circumstances or any treatment." 

Dr. John T. Hodgen (Ibid, p. 610) says: "In 
reviewing the history of the case of President Gar- 
field, I can find no reason for adverse criticism of 
any part of the management." 

Finally, while it is difficult and perhaps impossi- 
ble for any one to give a dispassionate judgment, in 
a case in which we were so deeply and personally 
interested as in that of the President, yet it is the 
deliberate conviction of the writer (as it was of all 
the surgeons in charge of the case) that the Presi- 
dent was mortally wounded when he received the 
fatal shot. Freely confessing our errors of diagnosis, 
yet we believed that no different course of treatment 
could have saved his life. I know that I speak only 
the truth when I say that no wounded man ever 
received more tender, loving and devoted service, not 
only from his surgeons but also from the faithful 
friends who nursed him through his long and weary 
illness. We gave him this cheerfully and would 
have sacrificed even our lives for him, if by so doing 
we could have saved his. We would have done this- 
not only because he was President, but because we^ 



108 



loved the man. Poor patient, uncomplaining, suf- 
fering President. How our hearts ached for him ; 
Member of Congress, Senator, President, stricken 
down at the time when he had received in rapid suc- 
cession the highest honors his country could bestow, 
he passed through days, weeks and months of suffer- 
ing, through the valley of the shadow of death, to 
that heavenly country, where there is neither sorrow, 
nor suffering nor pain. We can not understand why 
such things should be. We can only bow in humble 
submission to the will of Him who ruleth all things 
hoth in heaven and earth, and who doeth all things, 
well. 

THE END. 






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